David R Hillman

Sir Charles Gairdner Hospital, Perth City, Western Australia, Australia

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Publications (146)791.63 Total impact

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    ABSTRACT: To investigate whether low levels of physical activity were associated with an increased occurrence of obstructive sleep apnea (OSA), OSA-related symptoms, and cardiometabolic risk. A case-control study design was used. OSA cases were patients referred to a sleep clinic for suspected OSA (n = 2,340). Controls comprised participants from the Busselton community (n = 1,931). Exercise and occupational activity were derived from questionnaire data. Associations were modelled using logistic and linear regression and adjusted for confounders. In comparison with moderate exercise, the high, low, and nil exercise groups had an odds ratio (OR) for moderate-severe OSA of 0.6 (95% CI 0.5-0.8), 1.6 (95% CI 1.2-2.0), and 2.7 (95% CI 1.9-3.7), respectively. Relative to men in heavy activity occupations, men in medium, light and sedentary occupations had an OR for moderate-severe OSA of 1.7 (95% CI 1.1-2.5), 2.1 (95% CI 1.4-3.2), and 1.8 (95% CI 1.2-2.8), respectively. Relative to women in medium activity occupations, women in light and sedentary occupations had an OR for moderate-severe OSA of 4.2 (95% CI 2.6-7.2) and 3.5 (2.0-6.0). OSA patients who adequately exercised had lower: levels of doctor-diagnosed depression (p = 0.047); symptoms of fatigue (p < 0.0001); systolic (p = 0.015) and diastolic blood pressure (p = 0.015); and C-reactive protein (CRP) (p = 0.003). Low levels of physical activity were associated with moderate-severe OSA. Exercise in individuals with OSA is associated with lower levels of depression, fatigue, blood pressure and CRP. Copyright © 2015 American Academy of Sleep Medicine. All rights reserved.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 08/2015; 11(10). DOI:10.5664/jcsm.5078 · 3.05 Impact Factor
  • David R Hillman ·

    Anesthesia and analgesia 06/2015; 120(6):1182-3. DOI:10.1213/ANE.0000000000000666 · 3.47 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) is a common condition that has been associated with atrial fibrillation (AF), but there is a paucity of data from large longitudinal cohorts to establish whether OSA is a risk factor for AF independent of obesity and other established risk factors. We studied patients attending a sleep clinic referred for in-laboratory polysomnography for possible OSA between 1989 and 2001. Whole-population hospital data in Western Australia for 1970 to 2009 were linked to sleep study cases to determine incident AF hospitalization to 2009. Cox regression analyses were used to assess the independent association of OSA with incident AF. Study cases (6,841) were predominantly middle aged (48.3±12.5yr), male (77%) and 455 developed AF during a median 11.9 years follow-up. Univariate predictors of AF included age, body mass index, hypertension, diabetes, valvular heart disease, coronary or peripheral artery disease, heart failure, and chronic obstructive pulmonary disease (all P<0.001). After multivariable adjustment, independent predictors of incident AF were an apnea/hypopnea index (AHI)>5/hr, with hazard ratio (HR), 1.55 (95%CI 1.21- 2.00), log(AHI+1), HR 1.15 (95%CI 1.06 -1.26) and log (time with oxygen saturation less than 90% (SaO2<90%) +1), HR 1.12 (95%CI 1.06-1.19). There were no interactions between age, sex, or body mass index and AHI for AF development. OSA diagnosis and severity are independently associated with incident AF. Clinical trials are required to determine if treatment of OSA will reduce the burden of AF.
    Chest 04/2015; 148(4). DOI:10.1378/chest.15-0229 · 7.48 Impact Factor
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    ABSTRACT: To assess the efficacy of a novel female-specific autotitrating continuous positive airway pressure (CPAP) algorithm (AutoSet for her, AfH) in premenopausal women relative to a standard autotitrating algorithm (AutoSet, S9) (ResMed Ltd., Bella Vista, New South Wales, Australia). Prospective randomised crossover noninferiority trial. Tertiary hospital sleep clinic and university research sleep laboratory. 20 female patients with OSA established on long-term CPAP treatment. Treatment with 1 night each of AfH and AutoSet while monitored with overnight laboratory-based polysomnography (PSG); order randomly allocated. The primary outcome variables were the apnea/hypopnea index (AHI) and 3% oxygen desaturation index (ODI 3%) determined from PSG. Treatment efficacy on the AfH night was noninferior to the AutoSet night as assessed by median (IQR) AHI [1.2 (0.60-1.85)/h versus 1.15 (0.40-2.85)/h, respectively, P = 0.51] and 3% ODI [3.0 (1.5-15.5)/h versus 5.5 (1.5-10.5)/h, respectively, P = 0.90]. Other PSG measures were similar, except for the percentage of the night spent in flow limitation, which was lower on the AfH (0.14%) than the AutoSet night (0.19%, P = 0.007). The device-downloaded 95th centile pressure on the AfH night was also lower than on the AutoSet night [10.6 ± 1.7 versus 11.6 ± 2.6 cmH2O, respectively; mean difference (95% confidence interval): -1.1 (-2.13 to -0.01) cm H2O]. Among premenopausal women a novel female-specific autotitrating algorithm (AfH) is as effective as the standard AutoSet algorithm in controlling OSA. The new algorithm may reduce flow limitation more than the standard algorithm and achieve control of OSA at a lower (95th centile) pressure. Copyright © 2015 Associated Professional Sleep Societies, LLC. All rights reserved.
    Sleep 04/2015; 38(11). DOI:10.5665/sleep.5162 · 4.59 Impact Factor
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    ABSTRACT: To determine prevalence of depressive symptoms in obstructive sleep apnea (OSA) and the impact of OSA treatment on depression scores. Consecutive new patients referred for investigation of suspected OSA were approached. Consenting patients completed a Patient Health Questionnaire (PHQ-9) for depressive symptoms when attending for laboratory polysomnography (PSG). Those with moderate/ severe (apnea-hypopnea index [AHI] ≥15 events/h) and/ or symptomatic mild OSA (AHI 5 to <15 events/h) were offered continuous positive airway pressure (CPAP) therapy. PHQ-9 was repeated after 3 months of CPAP with compliance recorded. Of a maximum PHQ-9 score of 27, a cut point ≥10 (PHQ-9≥10) was used to indicate presence of clinically significant depressive symptoms. A total of 426 participants (243 males) were recruited. Mean (±SD) body mass index (BMI) was 32.1±7.1 kg/m2 and AHI 33.6±28.9 events/h. PHQ-9 was 10.5±6.1 and independently related to AHI (p < 0.001) and BMI (p < 0.001). In those without OSA, PHQ-9≥10 was more common in women, but no gender difference was evident with OSA. Of 293 patients offered CPAP, 228 were compliant (mean nightly use >5 h) over 3 months of therapy. In them, with therapy, AHI decreased from 46.7±27.4 to 6.5±1.6 events/h, PHQ-9 from 11.3±6.1 to 3.7±2.9 and PHQ-9≥10 from 74.6% to 3.9% (p < 0.001 in each case). Magnitude of change in PHQ-9 was similar in men and women. Antidepressant use was constant throughout. Depressive symptoms are common in OSA and related to its severity. They improve markedly with CPAP, implying a relationship to untreated OSA. Copyright © 2015 American Academy of Sleep Medicine. All rights reserved.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 03/2015; 11(9). DOI:10.5664/jcsm.5020 · 3.05 Impact Factor
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    ABSTRACT: In isolated airway smooth muscle (ASM) strips, an increase or decrease in ASM length away from its current optimum length causes an immediate reduction in force production followed by a gradual time-dependent recovery in force, a phenomenon termed length adaptation. In situ, length adaptation may be initiated by a change in transmural pressure (Ptm), which is a primary physiological determinant of ASM length. The present study sought to determine the effect of sustained changes in Ptm and therefore, ASM perimeter, on airway function. We measured contractile responses in whole porcine bronchial segments in vitro before and after a sustained inflation from a baseline Ptm of 5 cmH2O to 25 cmH2O, or deflation to -5 cmH2O, for ∼50 min in each case. In one group of airways, lumen narrowing and stiffening in response to electrical field stimulation (EFS) were assessed from volume and pressure signals using a servo-controlled syringe pump with pressure feedback. In a second group of airways, lumen narrowing and the perimeter of the ASM in situ were determined by anatomical optical coherence tomography. In a third group of airways, active tension was determined under isovolumic conditions. Both inflation and deflation reduced the contractile response to EFS. Sustained Ptm change resulted in a further decrease in contractile response, which returned to baseline levels upon return to the baseline Ptm. These findings reaffirm the importance of Ptm in regulating airway narrowing. However, they do not support a role for ASM length adaptation in situ under physiological levels of ASM lengthening and shortening. Copyright © 2015 the American Physiological Society.
    Journal of Applied Physiology 03/2015; 118(5):533-43. DOI:10.1152/japplphysiol.00724.2014 · 3.06 Impact Factor
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    ABSTRACT: We hypothesized that a dual-channel portable monitor (PM) device could accurately identify patients who have a high pretest probability of obstructive sleep apnea (OSA), and we evaluated factors that may contribute to variability between PM and polysomnography (PSG) results. Consecutive clinic patients (N = 104) with possible OSA completed a home PM study, a PM study simultaneous with laboratory PSG, and a second home PM study. Uniform data analysis methods were applied to both PM and PSG data. Primary outcomes of interest were the positive likelihood ratio (LR+) and sensitivity of the PM device to "rule-in" OSA, defined as an apnea hypopnea index (AHI) ≥5 events/h on PSG. Effects of different test environment and study nights, and order of study and analysis methods (manual compared to automated) on PM diagnostic accuracy were assessed. The PM has adequate LR+ (4.8), sensitivity (80%), and specificity (83%) for detecting OSA in the unattended home setting when benchmarked against laboratory PSG, with better LR+ (>5) and specificity (100%) and unchanged sensitivity (80%) in the simultaneous laboratory comparison. There were no significant night-night (all p > 0.10) or study order effects (home or laboratory first, p = 0.08) on AHI measures. Manual PM data review improved case finding accuracy, although this was not statistically significant (all p > 0.07). Misclassification was more frequent where OSA was mild. Overall performance of the PM device is consistent with current recommended criteria for an "acceptable" device to confidently "rule-in" OSA (AHI ≥5 events/h) in a high pretest probability clinic population. Our data support the utility of simple two-channel diagnostic devices to confirm the diagnosis of OSA in the home environment. © 2014 American Academy of Sleep Medicine.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2015; 11(4). DOI:10.5664/jcsm.4600 · 3.05 Impact Factor
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    David Hillman · Bhajan Singh · Nigel McArdle · Peter Eastwood ·
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    ABSTRACT: Conditions that increase load on respiratory muscles and/or reduce their capacity to cope with this load predispose to type 2 (hypercapnic) respiratory failure. In its milder forms, this imbalance between load and capacity may primarily manifest as sleep hypoventilation which, if untreated, can increase the likelihood of wakeful respiratory failure. Such problems are commonly seen in progressive respiratory neuromuscular disorders, morbid obesity and chronic obstructive pulmonary disease, either separately or together. Identifying patients at risk can be important in determining whether and when to intervene with treatments such as non-invasive ventilatory assistance. Measurements of wakeful respiratory function are fundamental to this risk assessment. These issues are reviewed in this paper.
    Respirology 10/2014; 19(8). DOI:10.1111/resp.12376 · 3.35 Impact Factor

  • 19th International Congress of the World-Muscle-Society; 10/2014
  • David R Hillman ·

    Anesthesia & Analgesia 10/2014; 119(4):753-754. DOI:10.1213/ANE.0000000000000379 · 3.47 Impact Factor
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    ABSTRACT: This study was designed to determine the effect of ground-based walking training on health-related quality of life and exercise capacity in people with chronic obstructive pulmonary disease (COPD). People with COPD were randomised to either a walking group that received supervised, ground-based walking training two to three times a week for 8-10 weeks, or a control group that received usual medical care and did not participate in exercise training. 130 out of 143 participants (mean±sd age 69±8 years, forced expiratory volume in 1 s 43±15% predicted) completed the study. Compared to the control group, the walking group demonstrated greater improvements in the St George's Respiratory Questionnaire total score (mean difference -6 points (95% CI -10- -2), p<0.003), Chronic Respiratory Disease Questionnaire total score (mean difference 7 points (95% CI 2-11), p<0.01) and endurance shuttle walk test time (mean difference 208 s (95% CI 104-313), p<0.001). This study shows that ground-based walking training is an effective training modality that improves quality of life and endurance exercise capacity in people with COPD.
    European Respiratory Journal 08/2014; 44(4). DOI:10.1183/09031936.00078014 · 7.64 Impact Factor
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    ABSTRACT: Relatively little is known about frequency and extent of respiratory problems in sporadic inclusion body myositis (IBM). To address this issue a study of peripheral muscle and respiratory function and related symptoms was performed in a cohort with biopsy-proven IBM. Dyspnoea, daytime sleepiness, dysphagia, spirometry, respiratory muscle strength, arterial blood gas tensions and ventilation during sleep were assessed. Sixteen patients were studied (10 males; age 68.1±9.9 years; disease duration 11.9±5.0 years; body mass index 28.5±4.0 kg/m2). Four reported excessive daytime sleepiness; 8 had at least mild dysphagia; forced vital capacity was <80% predicted normal in 7; sniff nasal inspiratory pressure was reduced in 3; daytime hypoxemia was present in 9 and hypercapnia in one. Sleep study was performed in 15 and revealed sleep disordered breathing (apnoea-hypopnoea index 23.4±12.8 (range 7-50.3) events/hr) in all. There were no consistent relationships between respiratory function impairment, occurrence of sleep disordered breathing, and severity of peripheral muscle weakness. Thus, asymptomatic impairment of respiratory function was common and sleep disordered breathing observed in all patients tested, irrespective of daytime respiratory function. This suggests respiratory function testing, including sleep study, should be performed routinely in IBM, irrespective of peripheral muscle function or other disease severity parameters.
    Neuromuscular Disorders 08/2014; 24(12). DOI:10.1016/j.nmd.2014.08.003 · 2.64 Impact Factor
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    ABSTRACT: Catheters that traverse the pharynx are often in place during clinical or research evaluations of upper airway function. The purpose of this study was to determine whether the presence of such catheters affects measures of upper airway collapsibility itself. To do so, pharyngeal critical closing pressure (Pcrit) and resistance upstream of the site of collapse Rus) were assessed in 24 propofol-anaesthetized subjects (14 men) with and without a multi-sensor oesophageal catheter (external diameter 2.7 mm) in place. Anaesthetic depth and posture were maintained constant throughout each study. Six subjects had polysomnography(PSG)-defined obstructive sleep apnea (OSA) and 18 either did not have or were at low risk of OSA. Airway patency was maintained with positive airway pressure. At intervals, pressure was reduced by varying amounts to induce varying degrees of inspiratory flow limitation. The slope of the pressure flow relationship for flow-limited breaths defined Rus. Pcrit was similar with the catheter in and out (−1.5 ± 5.4 cmH2O and −2.1 ± 5.6 cmH2O, respectively, P = 0.14, n = 24). This remained the case both for those with PSG-defined OSA (3.9 ± 2.2 cmH2O and 2.6 ± 1.4 cmH2O, n = 6) and those at low risk/without OSA (−3.3 ± 4.9 cmH2O and -3.7 ± 5.6 cmH2O, respectively, n = 18). Rus was similar with the catheter in and out (20.0 ± 12.3 cmH2O mL−1 s−1 and 16.8 ± 10.1 cmH2O mL−1 s−1, P = 0.22, n = 24). In conclusion, the presence of a small catheter traversing the pharynx had no significant effect on upper airway collapsibility in these anaesthestized subjects, providing reassurance that such measures can be made reliably in their presence.
    Journal of Sleep Research 08/2014; 24(1). DOI:10.1111/jsr.12193 · 3.35 Impact Factor
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    ABSTRACT: Introduction: Obstructive sleep apnea (OSA) is a common disorder that is associated with impaired attention, memory and executive function. However, the mechanisms underlying such dysfunction are unclear. To determine the influence of sleep fragmentation and hypoxia, this study examined the effect of sleep fragmentation and hypoxia on cognition in OSA, while controlling for potentially confounding variables including sleepiness, age and premorbid intelligence. Method: Participants with and without OSA (N = 150) were recruited from the general community and a tertiary hospital sleep clinic. All underwent comprehensive, laboratory-based polysomnography (PSG) and completed assessments of cognition including attention, short- and long-term memory and executive function. Structural equation modelling (SEM) was used to construct a theoretically-driven model to examine the relationships between hypoxia and sleep fragmentation, and cognitive function. Results: Although after controlling for IQ, increased sleep disturbance was a significant predictor of decreased attention (p = 0.04) and decreased executive function (p = 0.05), controlling for age removes these significant relationships. No significant predictors of memory function were found. Conclusions: The mechanisms underlying the effects of OSA on cognition remain to be defined. Implications are discussed in light of these findings.
    Sleep And Breathing 05/2014; 19(1). DOI:10.1007/s11325-014-1000-2 · 2.48 Impact Factor
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    ABSTRACT: There have been no studies of the effect of continuous positive airway pressure (CPAP) therapy on erectile dysfunction (ED) and serum testosterone in men with type 2 diabetes and obstructive sleep apnoea (OSA), a patient group at increased risk of ED and hypogonadism. The aim of the present study was to determine whether CPAP improves sexual and gonadal function in males with type 2 diabetes and a pre-CPAP apnoea-hypopnoea index >15/hour. Sub-study of a trial assessing the effect of three months of CPAP on cardiovascular risk in type 2 diabetes. Of 35 males starting CPAP, 27 (mean±SD age 65.4±9.6 years, median [interquartile range] diabetes duration 12.1 [5.2-15.3] years) completed the trial. Serum total and free testosterone, responses to the Androgen Deficiency in the Aging Male (ADAM) and Sexual Health Inventory for Men (SHIM) questionnaires. There were no significant changes in mean total or free testosterone (baseline concentrations 12.7±4.5 nmol/L and 0.26±0.07 pmol/L, respectively), or SHIM score (baseline 13 [5-17]), after three months of CPAP (P>0.20). The ADAM score (baseline 6.2±2.1) fell after one month (to 5.0±2.6) and was maintained at this level at three months (P=0.015). The Epworth Sleepiness Scale score decreased and self-reported physical activity increased over three months (P≤0.017) without a change in body mass index (P=1.00). These findings imply that CPAP therapy improves somnolence and promotes exercise in men with type 2 diabetes, but that there is no direct benefit for gonadal or sexual function. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2014; 81(2). DOI:10.1111/cen.12401 · 3.46 Impact Factor
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    David R Hillman · Leon C Lack ·
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    ABSTRACT: Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.
    The Medical journal of Australia 10/2013; 199(8):7-10. DOI:10.5694/mja13.10620 · 4.09 Impact Factor

  • The Medical journal of Australia 10/2013; 199(8):5-6. DOI:10.5694/mja13.11157 · 4.09 Impact Factor
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    ABSTRACT: (1) To describe the incidence rate of motor vehicle crashes (MVCs) in patients with obstructive sleep apnea (OSA); and (2) to investigate MVC risk factors in OSA patients. A retrospective case-series observational study was conducted using data from the West Australian Sleep Health Study at a tertiary hospital-based sleep clinic. Participants were patients (N = 2,673) referred for assessment of suspected sleep disordered breathing. Questionnaire data were collected including age, sex, years of driving, near-misses and MVCs, sleepiness, and consumption of alcohol and caffeinated drinks. Overnight laboratory-based polysomnography was performed using standard methodology.(1) Poisson univariate and negative binomial multivariable regression models were used to investigate associations between risk factors and MVC and near-miss risk in patients with untreated OSA. In patients with untreated OSA, the crash rate was 0.06 MVC/person-year compared with the general community crash rate of 0.02 MVC/person-year. The rate ratio comparing very sleepy men with normal men was 4.68 (95% CI 3.07, 7.14) for near-misses and 1.27 (95% CI 1.00, 1.61) for crashes, after adjusting for confounders. In women there was a significant association with sleepiness score (p = 0.02) but no dose effect across quartiles. Untreated OSA is associated with an increased risk of near-misses in men and women and an increased risk of MVCs in very sleepy men. There is a strong association between excessive daytime sleepiness and increased report of near-misses. Our data support the observation that it is those patients with increased sleepiness regardless of OSA severity who are most at risk. Ward KL; Hillman DR; James A; Bremner AP; Simpson L; Cooper MN; Palmer LJ; Fedson AC; Mukherjee S. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):1013-1021.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 10/2013; 9(10):1013-1021. DOI:10.5664/jcsm.3072 · 3.05 Impact Factor
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    ABSTRACT: The global trend of increased life expectancy and increased prevalence of chronic and degenerative diseases will impact on health systems. To identify effective intervention and prevention strategies, greater understanding of the risk factors for and cumulative effects of chronic disease processes and their effects on function and quality of life is needed.The Busselton Healthy Ageing Study aims to enhance understanding of ageing by relating the clustering and interactions of common chronic conditions in adults to function. Longitudinal (3--5 yearly) follow-up is planned.Methods/design: Phase I (recruitment) is a cross-sectional community-based prospective cohort study involving up to 4,000 'Baby Boomers' (born from 1946 to 1964) living in the Busselton Shire, Western Australia. The study protocol involves a detailed, self-administered health and risk factor questionnaire and a range of physical assessments including body composition and bone density measurements, cardiovascular profiling (blood pressure, ECG and brachial pulse wave velocity), retinal photography, tonometry, auto-refraction, spirometry and bronchodilator responsiveness, skin allergy prick tests, sleep apnoea screening, tympanometry and audiometry, grip strength, mobility, balance and leg extensor strength. Cognitive function and reserve, semantic memory, and pre-morbid intelligence are assessed. Participants provide a fasting blood sample for assessment of lipids, blood glucose, C-reactive protein and renal and liver function, and RNA, DNA and serum are stored. Clinically relevant results are provided to all participants. The prevalence of risk factors, symptoms and diagnosed illness will be calculated and the burden of illness will be estimated based on the observed relationships and clustering of symptoms and illness within individuals. Risk factors for combinations of illness will be compared with those for single illnesses and the relation of combinations of illness and symptoms to cognitive and physical function will be estimated. This study will enable a thorough characterization of multiple disease processes and their risk factors within a community-based sample of individuals to determine their singular, interactive and cumulative effects on ageing. The project will provide novel cross-sectional data and establish a cohort that will be used for longitudinal analyses of the genetic, lifestyle and environmental factors that determine whether an individual ages well or with impairment.
    BMC Public Health 10/2013; 13(1):936. DOI:10.1186/1471-2458-13-936 · 2.26 Impact Factor

Publication Stats

5k Citations
791.63 Total Impact Points


  • 1987-2015
    • Sir Charles Gairdner Hospital
      Perth City, Western Australia, Australia
  • 2013
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
  • 2011
    • University of Toronto
      Toronto, Ontario, Canada
  • 2009
    • The Queen's Medical Center
      Honolulu, Hawaii, United States
  • 2006
    • University of Western Australia
      • School of Electrical, Electronic and Computer Engineering
      Perth, Western Australia, Australia

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