H e a l i n g
t h e
B o d y
E n r i c h i n g
t h e
M i n d
N u r t u r i n g
t h e
S o u l
Compassionate care
led by Catholic values
Date _____________________________
To the Patient:
During routine preoperative screening you
were identified as being at risk for a condition
known as obstructive sleep apnea using a tool
known as STOP-Bang.
During your hospital stay your medical team
will monitor for any complications related to
this possible condition. It may be necessary
for you to stay in hospital overnight even if
discharge to home was initially planned.
Upon discharge from hospital, it is our
recommendation that you make an
appointment with your family doctor to
discuss the need for confirmatory testing
and/or treatment.
Please take this letter with you to your family
doctor as a means of informing them of the
potential of obstructive sleep apnea.
Patient
Label
STOP (Snore, Tired, Observed,
Pressure)
Have you ever been told that
you snore?
Are you often tired during the
day?
Has anyone observed you stop
breathing while sleeping?
Hypertension (>140/90 treated
or not)?
BANG (BMI, Age, Neck,
Gender)
Body mass index over 35?
Age over 50?
Neck circumference
>40cm/16in?
Male gender?
(Each ‘yes’ is one point, maximum 8
points)
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
STOP-Bang score ______________(High risk: 5-8, Intermediate risk: 3 or 4; Low risk: 0-2)
Sincerely,
___________________________________
Grey Nuns Community Hospital
Department of Anesthesiology
Chung, F., Subramanyam, R., Liao, P., Sasaki, E., Shapiro, C., & Sun, Y. (2012). High STOP-Bang score indicates a high
probability of obstructive sleep apnea. British Journal of Anaesthesia, 108(5), 768–775.
http://www.stopbang.ca
Grey Nuns Community Hospital
1100 Youville Drive West
Edmonton, Alberta T6L 5X8
Tel 780.735.7000
Fax 780.735.7500
www.CovenantHealth.ca