Graciela Emilia Silva Torres

Interests

Teaching

My philosophy in teaching is to give students all the necessary tools for them to be able to learn and apply their new knowledge so that students may perform their own evaluations. At the same time, students should be able to apply critical thinking, perform independent studies, and interpret their results.

Research

Asthma, Chronic Obstructive Pulmonary Diseases,Sleep and Sleep Disordered Breathing, Longitudinal Decline of Lung Function, Mixed Models, Random Effects Analyses, and Longitudinal Analyses.

Courses

Scholarly Contributions

Journals/Publications

• Callovini, L. C., Rojo-Wissar, D. M., Mayer, C., Glickenstein, D. A., Karamchandani, A. J., Lin, K. K., Thomson, C. A., Quan, S. F., Silva, G. E., & Haynes, P. L. (2023). Effects of sleep on breakfast behaviors in recently unemployed adults. Sleep health.
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  Skipping meals is linked to negative cardiometabolic health outcomes. Few studies have examined the effects of breakfast skipping after disruptive life events, like job loss. The present analyses examine whether sleep timing, duration, and continuity are associated with breakfast eating among 186 adults who recently (past 90 days) experienced involuntary unemployment from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study.
• Perfect, M. M., Silva, G. E., Chin, C. N., Wheeler, M. D., Frye, S. S., Mullins, V., & Quan, S. F. (2023). Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemporary clinical trials, 124, 106929.
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  Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
• Bethel, C., Crist, J. D., Shea, K., Silva, G. E., & Towers, V. (2021). A Guide for Intentional Home Telehealth Assessment: Patient and Caregiver Perceptions.. Computers, informatics, nursing : CIN, 39(12), 943-947. doi:10.1097/cin.0000000000000779
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  Telehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.
• Callovini, L., Glickenstein, D., Gubka, G., Haynes, P. L., Mayer, C., Quan, S. F., Rojo-wissar, D. M., Silva, G. E., & Thomson, C. A. (2021). 086 Sleep midpoint after job loss predicts breakfast skipping patterns. Sleep, 44(Supplement_2), A36-A36. doi:10.1093/sleep/zsab072.085
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  Abstract Introduction Few studies have examined circadian phase after job loss, an event that upends daily routine. It is common that a daily routine begins with the consumption of breakfast, and breakfast behavior may contribute to health status in adults. Therefore, we sought to examine whether a later midpoint of sleep was associated with breakfast skipping among adults whose schedules were no longer dictated by employment. Methods Data were obtained from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study. The sample of 155 participants had involuntarily lost their jobs in the last 90 days. Both cross-sectional and 18-month longitudinal analyses assessed the relationship between sleep midpoint after job loss and current and later breakfast skipping. Assessment periods were 14 days. Sleep was measured via actigraphy, and breakfast skipping was measured via daily diary (1 = had breakfast; 0 = did not have breakfast). The midpoint of sleep was calculated as the circular center based on actigraphy sleep onset and offset times. Results The midpoint of sleep at baseline was negatively associated with breakfast consumption at baseline (B = -.09, SE = .02, p = .000). Also, a later midpoint was associated with breakfast skipping over the next 18 months (estimate = -.08; SE = .02; p = .000). Prospective findings remained significant when adjusting for gender, ethnicity, age, perceived stress, body mass index (BMI), education, and reemployment over time. Education (estimate = 14.26, SE = 6.23, p < .05) and BMI (estimate = -.51, SE = .25, p < .05) were the only significant covariates. No other sleep indices predicted breakfast behavior cross-sectionally or prospectively. Conclusion Consistent with research in adolescents, unemployed adults with a later circadian phase are more likely to skip breakfast more often. Breakfast skipping was also associated with higher BMI. Taken together, these findings provide support for the future testing of sleep/wake scheduling interventions to modify breakfast skipping and potentially mitigate weight gain after job loss. Support (if any) #1R01HL117995-01A1
• Perfect, M. M., Silva Torres, G. E., Wheeler, M. D., Chin, C., Bluez, G. P., & Elrokshsi, S. (2020). Differences in Sleep Architecture According to Body Mass Index in Children with Type 1 Diabetes. Diabetes.
• Silva, G. E., Muramoto, M. L., Loescher, L. J., & Heslin, K. M. (2021). Incorporating Decision Simulation Technology in a Skin Cancer Prevention E-Training for Massage Therapists. Journal of Cancer Education. doi:10.1007/s13187-021-02081-4
• Silva, G. E., Quan, S. F., Silva, G. E., Quan, S. F., Mcmorrow, T. E., Haynes, P. L., Bell, M. L., & Bautista, R. (2021). Association between obstructive sleep apnea and multiple involuntary job loss history among recently unemployed adults.. Sleep health, 7(1), 118-122. doi:10.1016/j.sleh.2020.08.002
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  Obstructive sleep apnea (OSA) has been associated with negative occupational outcomes including absenteeism and poor work productivity. This analysis explored whether the severity of OSA was associated with multiple involuntary job loss history among recently unemployed adults..This is a cross-sectional analysis of data from the screening visit of the Assessing Daily Activity Patterns Through Occupational Transitions study. Information was collected from 261 participants who recently involuntarily lost their jobs. Data included demographics, employment, medical history, and results from a limited channel home sleep apnea test. The respiratory event index was categorized as
• Silva, G. E., Rojo-Wissar, D. M., Quan, S. F., & Haynes, P. L. (2021). Predictive ability of the International Classification of Sleep Disorders-3 in identifying risk of obstructive sleep apnea among recently unemployed adults. Sleep & breathing = Schlaf & Atmung.
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  The International Classification of Sleep Disorders (ICSD)-3 was developed to aid in the identification of these disorders. The core criterion A (ICSD-3A) to identify obstructive sleep apnea (OSA) requires the presentence of specific signs and symptoms. This study explores the predictive ability of the ICSD-3A for OSA as compared with objective measures of respiratory event index (REI).
• Towers, V., Silva, G. E., Shea, K. M., & Koon, M. (2021). Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment. Telemedicine Reports, 2(1), 32-38. doi:10.1089/tmr.2020.0017
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  Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualiz...
• Vana, K. D., Silva, G. E., Carreon, J. D., & Quan, S. F. (2021). Using anthropometric measures to screen for obstructive sleep apnea in the Sleep Heart Health Study cohort. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(8), 1635-1643.
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  To evaluate predictions of moderate to severe obstructive sleep apnea (MS-OSA) by the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) and compare to the derived STOP-Bang Questionnaire (dSBQ) prediction.
• Chen, S., Quan, S. F., Silva, G. E., Powers, L. S., Roveda, J. M., Silva, G. E., Roveda, J. M., Quan, S. F., Powers, L. S., Perfect, M. M., Li, A., Chen, S., & Ackerman, C. (2020). Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students.. Sleep medicine, 67, 191-199. doi:10.1016/j.sleep.2019.12.001
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  This study investigates sleep patterns of fourth- and fifth-grade students using actigraphy..The study included 257 students enrolled in a Southwestern US school district who participated in a novel sleep science curriculum during the Spring 2016-17 and Fall 2017-18 semesters and met the study inclusion criteria. As part of this curriculum, participants underwent 5-7 days of continuous wrist actigraphy and completed an online sleep diary..Approximately two-thirds of the 9-11-year-old fourth- and fifth-grade students slept less than the minimum 9 h per night recommended by both the American Academy of Sleep Medicine/Sleep Research Society and the National Sleep Foundation. The sleep midpoint time on weekends was about 1 h later than on weekdays. There was a significant effect of age on sleep duration. Compared to 9-year old students, a larger proportion of 10-year old students had a sleep duration less than 8.5 h. Boys had shorter sleep duration than girls, and a larger percentage of boys obtained less than 9 h of sleep compared to girls..Insufficient sleep is a highly prevalent condition among 9-11-year-old fourth- and fifth-grade elementary students. Importantly, there is a difference between sleep patterns on weekdays and weekends which may portend greater problems with sleep in adolescence and young adulthood.
• Elrokhsi, S. H., Bluez, G. P., Chin, C. N., Wheeler, M. D., Silva, G. E., & Perfect, M. M. (2020). Differences in sleep architecture according to body mass index in children with type 1 diabetes. Pediatric diabetes, 21(1), 98-105.
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  Slow wave sleep (SWS), or deep sleep, is thought to be the most restorative stage of sleep and may be of a particular interest in the pathophysiology of obesity. The aim of this study was to investigate differences in sleep architecture based on body mass index (BMI) among a pediatric population with type 1 diabetes mellitus (T1DM). We hypothesized that children with T1DM who are obese would have less SWS than those who are not obese. Of 105 children with T1DM (mean age 13.54 years, 49.5% females) in this study, 19% were obese, 22% were overweight, and 59% had a normal BMI (81% non-obese). The overall SWS% among the participants was 13.2%. In contrast to our hypothesis, there was no significant difference in SWS% between obese and non-obese participants. However, the percent of time spent in rapid eye movement (REM) sleep among obese participants was significantly lower than those who were not obese (P = .022), which remained after adjusting the result for multiple covariates. While we found no significant association between the SWS time and BMI, obese adolescents with T1DM spent less time in REM sleep than those who were not obese. This study adds to the growing body of evidence supporting the importance of addressing sleep in clinical care of youth with T1DM.
• Fitzpatrick, J. M., Silva, G. E., & Vana, K. D. (2020). Perceived Barriers and Facilitating Factors in Implementing Delayed School Start Times to Improve Adolescent Sleep Patterns. The Journal of school health.
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  Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high-school start times.
• Loescher, L., Heslin, K., Silva, G., & Muramoto, M. (2020). Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study. JMIR formative research, 4(11), e21309.
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  Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non-health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients' skin on a regular basis, which can allow MTs to initiate "helping conversations" (ie, brief behavioral interventions aimed at reducing the risk of skin cancer).
• Shea, K. D., Silva Torres, G. E., Towers, V., & Koon, M. (2021). Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment.. Telemedicine Reports.
• Silva Torres, G. E., Quan, S. F., McMorrow, T., Bautista, R., Bell, M. L., & Haynes, P. L. (2019). Association between obstructive sleep apnea and multiple involuntary job loss history among recently unemployed individuals. Sleep Health.
• Silva, G. E., Quan, S. F., Haynes, P. L., Glickenstein, D. A., Thomson, C. A., Silva, G. E., Quan, S. F., Kobayashi, U., Haynes, P. L., Glickenstein, D. A., & Apolinar, G. R. (2020). 1047 Social Rhythm Instability Is Associated With Abdominal Adiposity After Involuntary Job Loss. Sleep, 43(Supplement_1), A397-A398. doi:10.1093/sleep/zsaa056.1043
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  Abstract Introduction Involuntary job loss is an acute stressor that disrupts daily time structure and activity and exacerbates economic hardship and psychological distress. Studies show that unemployment is associated with negative obesity-related health outcomes, such as metabolic syndrome. However, very little is known about daily routine, depression, and obesity in individuals who have recently experienced involuntary job loss. We hypothesized that individuals with less consistent daily routines, or unstable social rhythms, after job-loss would have more abdominal adiposity than individuals with more consistent social rhythms. We also hypothesized that this relationship would vary as a function of depressive symptoms. Methods Cross-sectional baseline data (n = 186) from the ongoing ADAPT study (Assessing Daily Activity Patterns through occupational Transitions) were analyzed using linear regression techniques. Participants were predominantly female (62%) with a mean age of 41.12 years (SD = 10.16 years); 31% were Hispanic or Latino. Over two weeks, participants completed the daily Social Rhythm Metric-17 (SRM), Beck Depression Inventory II (BDI), and waist circumference (adiposity) measurements (cm). Results A significant BDI x SRM interaction was detected in the prediction of waist circumference, B = .36, SE = .18, p < .05, 95% CI [.002, .709], R2 = .07). The SRM was inversely associated with waist circumference, B = -5.57, SE = 2.25, p < .05, 95% CI [-9.98, -1.13], only at lower levels of BDI (-1 SD below the mean). Results from the Johnson-Neyman technique identified that the conditional effect of SRM on waist circumference was statistically significant at a BDI raw score of 8.33 (0-13 points is minimal depression) with ~45% of cases within this region. Conclusion A less consistent daily routine was associated with a larger waist circumference among individuals with minimal depressive symptoms. These findings are the first to demonstrate a relationship between social rhythm stability and abdominal adiposity in adults at high risk for central obesity. Results highlight the moderating role of depression in obesity prevention. Future prospective analysis is necessary to examine causal pathways. Support #1R01HL117995-01A1
• Silva, G. E., Quan, S. F., McMorrow, T., Bautista, R., Bell, M. L., & Haynes, P. L. (2020). Association between obstructive sleep apnea and multiple involuntary job loss history among recently unemployed adults. Sleep health.
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  Obstructive sleep apnea (OSA) has been associated with negative occupational outcomes including absenteeism and poor work productivity. This analysis explored whether the severity of OSA was associated with multiple involuntary job loss history among recently unemployed adults.
• Silva, G. E., Quan, S. F., Vana, K. D., Silva, G. E., Quan, S. F., & Carreon, J. D. (2020). 0572 Using Anthropometric Measures to Screen for Obstructive Sleep Apnea in the Sleep Heart Health Study Cohort. Sleep, 43(Supplement_1), A219-A219. doi:10.1093/sleep/zsaa056.569
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  Abstract Introduction Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group quickly. We compared the sensitivities (SNs), specificities (SPs), and receiving operator curves (ROCs) of the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) in predicting moderate and severe OSA (apnea-hypopnea index [AHI] ≥15/hr) with the SN, SP, and ROC of the derived Stop-Bang Questionnaire (dSBQ), which was created from proxy variables from the Sleep Heart Health Study (SHHS). Methods Data from the SHHS baseline evaluation were used and included participants (N=5431) who completed polysomnograms and had neck and waist circumferences, height measurements, and the SHHS proxy variables. This data then was divided randomly into 1/3 for derivation and 2/3 for validation analyses. Results No statistical differences were seen for gender, age, or ethnicity between the derivation and validation samples. In the validation sample (n=3621), the NHR cut-point of 0.21 resulted in a SN of 91% and a SP of 26% for AHI ≥15/hr. The WHR cut-point of 0.51 resulted in a SN of 91% and a SP of 21% for AHI ≥15/hr. Comparing the validation NHR and the dSBQ ROC curves showed no significant difference (AUCs=0.69 and 0.70, respectively; p=0.22). However, the ROC curve for WHR was significantly lower than for the dSBQ (AUCs=0.63 and 0.70, respectively; p
• Butler, E. A., Glickenstein, D. A., Silva Torres, G. E., Quan, S. F., Thomson, C. A., & Haynes, P. L. (2019). Inconsistent Social Rhythms are Associated with Higher Waist Circumference Following Job Loss. Society of Behavioral Medicine annual meeting.
• Frye, S. S., Perfect, M. M., & Silva, G. E. (2019). Diabetes management mediates the association between sleep duration and glycemic control in youth with type 1 diabetes mellitus. Sleep medicine, 60, 132-138.
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  The purpose of this study was to examine the associations of diabetes management and sleep duration with glycemic control in youth with type 1 diabetes mellitus.
• Haynes, P. L., Silva, G. E., Glickenstein, D. A., Thomson, C. A., Skulas-ray, A. C., Silva, G. E., Rojo-wissar, D. M., Mayer, C., Haynes, P. L., & Glickenstein, D. A. (2019). 0176 Longer Sleep Duration Precedes Greater Water Intake At Breakfast. Sleep, 42(Supplement_1), A72-A72. doi:10.1093/sleep/zsz067.175
• Kindarara, D. M., & Silva, G. E. (2019). Prevalence and Associated Risk Factors of Diabetes in the African Immigrant Population of Sacramento County, California. The Diabetes educator, 45(2), 225-239.
• Li, A., Chen, S., Quan, S. F., Silva, G. E., Ackerman, C., Powers, L. S., Roveda, J. M., & Perfect, M. M. (2019). Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students. Sleep medicine, 67, 191-199.
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  This study investigates sleep patterns of fourth- and fifth-grade students using actigraphy.
• Loescher, L. J., Heslin, K. M., Szalacha, L. A., Silva, G. E., & Muramoto, M. L. (2019). Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study. JMIR research protocols, 8(5), e13480.
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  Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients' skin and are amenable to performing skin cancer risk reduction activities during massage appointments.
• Muramoto, M. L., Silva Torres, G. E., Szalacha, L. A., Heslin, K. M., & Loescher, L. J. (2019). Online Skin Cancer Prevention Training for Massage Therapists: Protocol for the MTsSHARE Study: A Research Protocol. Journal of Medical Internet Research Protocols, 8(5), 4-15. doi:doi:10.2196/13480
• Quan, S. F., Silva, G. E., Roveda, J. M., Silva, G. E., Roveda, J. M., Quan, S. F., Perfect, M. M., & Li, A. (2018). A Novel Artificial Neural Network Based Sleep-Disordered Breathing Screening Tool.. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1063-1069. doi:10.5664/jcsm.7182
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  This study evaluated a novel artificial neural network (ANN) based sleep-disordered breathing (SDB) screening tool incorporating nocturnal pulse oximetry with demographic, anatomic, and clinical data. The tool was compatible with 6 categories of apnea-hypopnea index (AHI) with 4% oxyhemoglobin desaturation threshold, ≥ 5, 10, 15, 20, 25, and 30 events/h..Using a general population dataset, the training set included 2,280 subjects, whereas the test set included 470 subjects. The input of this tool was a set of 22 variables. The tool had six neural network models for each AHI threshold. Several metrics were explored to evaluate the performance of the tool: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and 95% confidence interval (CI)..The AUC was 0.904, 0.912, 0.913, 0.926, 0.930, and 0.954, respectively, with models of AHI ≥ 5, 10, 15, 20, 25, and 30 events/h thresholds. The sensitivities of all neural network models were higher than 95%. The AHI ≥ 30 events/h model had the maximum sensitivity: 98.31% (95% CI: 95.01%-100%)..The results of this study suggested that the ANN based SDB screening tool can be used to identify the presence or absence of SDB. Future validation should be performed in other populations to determine the practicability of this screening tool in sleep clinics and other at-risk populations.
• Haynes, P. L., Silva, G. E., Howe, G. W., Thomson, C. A., Butler, E. A., Quan, S. F., Sherrill, D., Scanlon, M., Rojo-Wissar, D. M., Gengler, D. N., & Glickenstein, D. A. (2017). Longitudinal assessment of daily activity patterns on weight change after involuntary job loss: the ADAPT study protocol. BMC public health, 17(1), 793.
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  The World Health Organization has identified obesity as one of the most visible and neglected public health problems worldwide. Meta-analytic studies suggest that insufficient sleep increases the risk of developing obesity and related serious medical conditions. Unfortunately, the nationwide average sleep duration has steadily declined over the last two decades with 25% of U.S. adults reporting insufficient sleep. Stress is also an important indirect factor in obesity, and chronic stress and laboratory-induced stress negatively impact sleep. Despite what we know from basic sciences about (a) stress and sleep and (b) sleep and obesity, we know very little about how these factors actually manifest in a natural environment. The Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study tests whether sleep disruption plays a key role in the development of obesity for individuals exposed to involuntary job loss, a life event that is often stressful and disrupting to an individual's daily routine.
• Silva, G. E., Quan, S. F., Silva, G. E., Rojo-wissar, D. M., Quan, S. F., & Haynes, P. L. (2017). 0484 SENSITIVITY AND SPECIFICITY OF THE DUKE STRUCTURED INTERVIEW FOR SLEEP DISORDERS TO ASSESS SLEEP DISORDERED BREATHING. Sleep, 40(suppl_1), A180-A181. doi:10.1093/sleepj/zsx050.483
• Vana, K. D., & Silva, G. E. (2014). Evaluating the use of a simulated electronic health record and online drug reference in a case study to enhance nursing students' understanding of pharmacologic concepts and resources. Nurse educator, 39(4), 160-5.
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  Nursing students should learn to navigate the complexities of the healthcare arena, such as integrating use of electronic health records (EHRs) and online drug references into patient care. Using a simulated EHR in a nursing pharmacology course allowed students to interact with these technologies while learning and applying pharmacologic concepts to a case study. The authors discuss how they created and facilitated such a case study, as well as students' outcomes.
• Nahapetian, R., Silva, G. E., Vana, K. D., Parthasarathy, S., & Quan, S. F. (2016). Weighted STOP-Bang and screening for sleep-disordered breathing. Sleep & breathing = Schlaf & Atmung, 20(2), 597-603.
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  STOP-Bang is a tool for predicting the likelihood for sleep-disordered breathing (SDB). In the conventional score, all variables are dichotomous. Our aim was to identify whether modifying the STOP-Bang scoring tool by weighting the variables could improve test characteristics.
• Silva, G. E., Goodwin, J. L., Vana, K. D., & Quan, S. F. (2016). Obstructive Sleep Apnea and Quality of Life: Comparison of the SAQLI, FOSQ, and SF-36 Questionnaires. Southwest journal of pulmonary & critical care, 13(3), 137-149.
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  The impact of sleep on quality of life (QoL) has been well documented; however, there is a great need for reliable QoL measures for persons with obstructive sleep apnea (OSA). We compared the QoL scores between the 36-Item Short Form of the Medical Outcomes Survey (SF-36), Calgary Sleep Apnea Quality of Life Index (SAQLI), and Functional Outcomes Sleep Questionnaire (FOSQ) in persons with OSA.
• Silva, G. E., Goodwin, J. L., Vana, K. D., Vasquez, M. M., Wilcox, P. G., & Quan, S. F. (2014). Restless legs syndrome, sleep, and quality of life among adolescents and young adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 10(7), 779-86.
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  Clinical reports in children implicate restless legs syndrome (RLS) with sleep and behavior problems. However, population-based studies on this association in adolescents and young adults are limited. Furthermore, few studies have evaluated the association between symptoms consistent with RLS and quality of life (QoL).
• Archibald, K., Silva, G. E., Quan, S. F., Vasquez, M. M., Silva, G. E., Quan, S. F., & Goodwin, J. L. (2013). Incidence and remission of sleep related symptoms in children and associations with health-related quality of life; A 7-year follow-up of the TuCASA cohort. Sleep Medicine, 14, e268. doi:10.1016/j.sleep.2013.11.653
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  Introduction Sleep disturbances are common in adolescents; some studies have shown that this may adversely affect their quality of life. However, there is little evidence on incidence and remission of sleep problems from childhood to adolescence and the association with health-related quality of life (QoL). Materials and methods Sleep Screening questionnaires were collected on Hispanic and Caucasian children 6–12 years of age at baseline, and again 7 years after during follow-up, when participants were 12–20 years. Excessive daytime sleepiness (EDS) and difficulty initiating and maintaining sleep (DIMS) were present if they occurred frequently or more. Health-related QoL was assessed at follow-up using the Pediatric Quality of Life Inventory and three summary scores, ranging from 1 to 100, were evaluated: psychosocial health (PS), physical function (PF), and total scale scores (TS). Prevalence, incidence, and remission of sleep symptoms were computed and analyzed for association with health-related QoL. Results The mean ages at baseline and follow-up were 8.8 and 15.4 years. There were 50.2% males and 30.6% Hispanics. Incidence rates of EDS and DIMS were 39.1% and 58.9%, and remission rates were 53.1% and 36.2%, respectively. Separate linear regressions models predicting health-related QoL showed that participants with persistent EDS had lower mean values for TS (coeff. = −9.2, p  = .006), PS (coeff. = −8.8, p  = .025), and PF (coeff. = −10, p  = .002) as compared with participants who never had EDS or those with remittent EDS combined. Participants with persistent DIMS had lower mean values for TS (coeff. = −6.8, p  = .001) and PS (coeff. = −8.4, p  = .001) as compared with participants who never had DIMS or those with remittent DIMS combined. When participants with persistent DIMS were compared with those with remittent DIMS only, the associations between DIMS and health-related QoL, became non-significant. However, the association between EDS and health-related QoL remained (coeff. = −13.3, p  = .02). Conclusion Substantial variability of self-reports of sleep problems exists as children age from childhood to adolescence. Nevertheless, there are a small number of young children who persistently have sleep problems over this age span and these problems are associated with lower health-related quality of life. These associations appear to be driven primarily by EDS. Acknowledgements The TuCASA study was supported by NHLBI grant HL 62373 . Silva, G.E. was supported by NHLBI grant HL 62373-05A2S1 .
• Shaw, N. D., Goodwin, J. L., Silva, G. E., Hall, J. E., Quan, S. F., & Malhotra, A. (2013). Obstructive Sleep Apnea (OSA) in preadolescent girls is associated with delayed breast development compared to girls without OSA. Journal of Clinical Sleep Medicine, 9(8), 813-818.
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  PMID: 23946712;PMCID: PMC3716673;Abstract: Study Objective: Adults with obstructive sleep apnea (OSA) have lower sex steroid levels than controls. We sought to determine whether OSA also interferes with reproductive hormones in adolescence by tracking the pace of pubertal development. Methods: One hundred seventy-two children in the Tucson Children's Assessment of Sleep Apnea study (TuCASA) underwent two home polysomnographic studies, spaced 4-5 years apart. Height and weight were measured at both visits, and Tanner staging of breasts/genitals and pubic hair were self-assessed by a pictorial questionnaire at follow-up. Results: Eighty-seven girls and 85 boys, age 8.9 ± 1.6 years (mean ± SD) at baseline and 13.4 ± 1.6 years at follow-up, participated. Twenty-seven percent of participants were overweight or obese at baseline, and the majority remained so at follow-up. Twenty-six percent of girls and 28% of boys met criteria for OSA, defined as a respiratory disturbance index (RDI) ≥ 1/h associated with a 3% desaturation (RDI 3%), at baseline. There was an inverse relationship between baseline log RDI 3% and Tanner breast stage at follow-up (coefficient -1.3, p = 0.02) in girls after adjusting for age (p < 0.001), body mass index (p < 0.005), and ethnicity. Girls with OSA at baseline were more than 1 Tanner breast stage behind girls without OSA at follow-up. OSA did not affect genital development in boys or pubic hair development in either sex. Conclusions: OSA in preadolescent girls predicts delayed breast development relative to girls without OSA. Sleep fragmentation and/or hypoxia seen in OSA may interfere with reproductive development in girls.
• Vana, K. D., Silva, G. E., & Goldberg, R. (2013). Predictive abilities of the STOP-Bang and Epworth Sleepiness Scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Research in Nursing and Health, 36(1), 84-94.
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  PMID: 23007730;Abstract: This study compared the predictive abilities of the STOP-Bang and Epworth Sleepiness Scale (ESS) for screening sleep clinic patients for obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB). Forty-seven new adult patients without previous diagnoses of OSA or SDB were administered the STOP-Bang and ESS and were assigned to OSA or SDB risk groups based on their scores. STOP-Bang responses were scored with two Body Mass Index cut points of 35 and 30kg/m2 (SB35 and SB30). The tools' predictive abilities were determined by comparing patients' predicted OSA and SDB risks to their polysomnographic results. The SB30 correctly identified more patients with OSA and SDB than the ESS alone. The ESS had the highest specificity for OSA and SDB. © 2012 Wiley Periodicals, Inc.
• Brown, M. A., Goodwin, J. L., Silva, G. E., Behari, A., Newman, A. B., Punjabi, N. M., Resnick, H. E., Robbins, J. A., & Quan, S. F. (2011). The Impact of Sleep-Disordered Breathing on Body Mass Index (BMI): The Sleep Heart Health Study (SHHS). Southwest journal of pulmonary & critical care, 3, 159-168.
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  INTRODUCTION: It is well known that obesity is a risk factor for sleep-disordered breathing (SDB). However, whether SDB predicts increase in BMI is not well defined. Data from the Sleep Heart Health Study (SHHS) were analyzed to determine whether SDB predicts longitudinal increase in BMI, adjusted for confounding factors. METHODS: A full-montage unattended home polysomnogram (PSG) and body anthropometric measurements were obtained approximately five years apart in 3001 participants. Apnea-hypopnea index (AHI) was categorized using clinical thresholds: < 5 (normal), ≥ 5 to
• Drescher, A. A., Goodwin, J. L., Silva, G. E., & Quan, S. F. (2011). Caffeine and screen time in adolescence: Associations with short sleep and obesity. Journal of Clinical Sleep Medicine, 7(4), 337-342.
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  PMID: 21897768;PMCID: PMC3161764;Abstract: Objective: To investigate the associations between sleep duration and obesity incidence and risk factors among preadolescents and adolescents. Design: Cross-sectional study of a community based cohort Setting: The Tucson Children's Assessment of Sleep Apnea follow-up study (TuCASA) cohort. Participants: 319 Caucasian and Hispanics between 10-17 years. Main Outcome: Parent-reported sleep duration and BMI zscore. Outcome Measures: Surveys of electronic screen time, dietary and caffeine intake, exercise and sleep habits by parents, and anthropometric measures. Results: Parent-reported total sleep time (TST) was inversely associated with BMI z-score, but not signifi cantly correlated with any of the examined nutritional variables or exercise components. Hispanic ethnicity was associated with signifi cantly lower parent-reported TST and higher BMI z-score. Parentreported TST was inversely related to electronic screen time and caffeine use, but these fi ndings were differentially related to age. Caffeine consumption was associated with decreasing parent-reported TST primarily in older adolescents. Electronic screen time was associated with lower parent-reported TST in Younger adolescents. Conclusions: Hispanic ethnicity and parental reports of TST were found to be the most closely associated with BMI z-score. Decreased TST and increased caffeine intake and screen time may result in higher obesity risk in the adolescent population.
• Silva, G. E., Goodwin, J. L., Parthasarathy, S., Sherrill, D. L., Vana, K. D., Drescher, A. A., & Quan, S. F. (2011). Longitudinal association between short sleep, body weight, and emotional and learning problems in hispanic and caucasian children. Sleep, 34(9), 1197-1205.
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  PMID: 21886357;PMCID: PMC3157661;Abstract: Study Objective: To determine the impact of lower amounts of childhood sleep assessed by polysomnogram on development of obesity, being anxious or depressed, or having learning problems 5 years later. Design: Prospective cohort. Participants: Subjects were 304 community participants from the Tucson Children's Assessment of Sleep Apnea study, aged 6-12 years old at baseline. Measurements and Results: Children were classified according to baseline sleep as those who slept ≥ 9 h/night, those who slept > 7.5 to < 9 h/ night, and those who slept ≤ 7.5 h/night. Odds of overweight/obese (≥ 85 th BMI percentile), obese (≥ 95th BMI percentile), anxious or depressed, and learning problems at follow-up were assessed according to baseline sleep categories. Children who slept ≤ 7.5 h/night had higher odds of being obese (OR = 3.3, P < 0.05) at follow-up than children who slept ≥ 9 h/night. Borderline significance for overweight/obese (OR = 2.2, P < 0.1), anxious or depressed (OR = 3.3, P < 0.1), and having learning problems (OR = 11.1, P < 0.1) were seen for children who slept ≤ 7.5 h/night as compared to those who slept ≥ 9 h/night. A mean increase in BMI of 1.7 kg/m 2 (P = 0.01) over the 5 years of follow-up was seen for children who slept ≤ 7.5 h/night compared to those who slept ≥ 9 h/night. These relationships did not differ between Hispanic and Caucasian children. Conclusions: Children with reduced amounts of sleep (≤ 7.5 h/night) had an increased risk for higher body weight in early adolescence. Similarly, children who slept ≤ 7.5 h/night had higher risk of being anxious or depressed or having learning problems in early adolescence.
• Silva, G. E., Vana, K. D., Goodwin, J. L., Sherrill, D. L., & Quan, S. F. (2011). Identification of patients with sleep disordered breathing: Comparing the four-variable screening tool, STOP, STOP-bang, and epworth sleepiness scales. Journal of Clinical Sleep Medicine, 7(5), 467-472.
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  PMID: 22003341;PMCID: PMC3190845;Abstract: Study Objective: The Epworth Sleepiness Scale (ESS) has been used to detect patients with potential sleep disordered breathing (SDB). Recently, a 4-Variable screening tool was proposed to identify patients with SDB, in addition to the STOP and STOP-Bang questionnaires. This study evaluated the abilities of the 4-Variable screening tool, STOP, STOP-Bang, and ESS questionnaires in identifying subjects at risk for SDB. Methods: A total of 4,770 participants who completed polysomnograms in the baseline evaluation of the Sleep Heart Health Study (SHHS) were included. Subjects with RDIs ≥ 15 and ≥ 30 were considered to have moderate-to-severe or severe SDB, respectively. Variables were constructed to approximate those in the questionnaires. The risk of SDB was calculated by the 4-Variable screening tool according to Takegami et al. The STOP and STOP-Bang questionnaires were evaluated including variables for snoring, tiredness/sleepiness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender. Sleepiness was evaluated using the ESS questionnaire and scores were dichotomized into < 11 and ≥ 11. Results: The STOP-Bang questionnaire had higher sensitivity to predict moderate-to-severe (87.0%) and severe (70.4%) SDB, while the 4-Variable screening tool had higher specificity to predict moderate-to-severe and severe SDB (93.2% for both). Conclusions: In community populations such as the SHHS, high specificities may be more useful in excluding low-risk patients, while avoiding false positives. However, sleep clinicians may prefer to use screening tools with high sensitivities, like the STOP-Bang, in order to avoid missing cases that may lead to adverse health consequences and increased healthcare costs.
• Vana, K. D., Silva, G. E., Muzyka, D., & Hirani, L. M. (2011). Effectiveness of an audience response system in teaching pharmacology to baccalaureate nursing students. CIN - Computers Informatics Nursing, 29(SUPPL. 6), TC105-TC113.
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  PMID: 21701273;Abstract: It has been proposed that students' use of an audience response system, commonly called clickers, may promote comprehension and retention of didactic material. Whether this method actually improves students' grades, however, is still not determined. The purpose of this study was to evaluate whether a lecture format utilizing multiple-choice PowerPoint slides and an audience response system was more effective than a lecture format using only multiple-choice PowerPoint slides in the comprehension and retention of pharmacological knowledge in baccalaureate nursing students. The study also assessed whether the additional use of clickers positively affected students' satisfaction with their learning. Results from 78 students who attended lecture classes with multiple-choice PowerPoint slides plus clickers were compared with those of 55 students who utilized multiple-choice PowerPoint slides only. Test scores between these two groups were not significantly different. A satisfaction questionnaire showed that 72.2% of the control students did not desire the opportunity to use clickers. Of the group utilizing the clickers, 92.3% recommend the use of this system in future courses. The use of multiple-choice PowerPoint slides and an audience response system did not seem to improve the students' comprehension or retention of pharmacological knowledge as compared with those who used solely multiple-choice PowerPoint slides. Copyright © 2011 Wolters Kluwer Health. Lippincott Williams & Wilkins.
• Goodwin, J. L., Vasquez, M. M., Silva, G. E., & Quan, S. F. (2010). Incidence and Remission of Sleep-Disordered Breathing and Related Symptoms in 6- to 17-Year Old Children-The Tucson Children's Assessment of Sleep Apnea Study. Journal of Pediatrics, 157(1), 57-61.
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  PMID: 20304429;PMCID: PMC2886190;Abstract: Objective: To determine the incidence and remission of sleep-disordered breathing in adolescent children. Study design: A total of 319 children completed 2 home polysomnograms approximately 5 years apart. Sleep-disordered breathing (SDB) was determined to be present if a child had a respiratory disturbance index ≥ 1 event per hour associated with ≥3% oxygen desaturation. Subjective symptoms such as witnessed apnea, excessive daytime sleepiness, difficulty initiating and maintaining sleep, and habitual loud snoring were considered present if they occurred frequently or almost always. Body mass index percentiles were calculated with childhood growth charts from the Centers for Disease Control and Prevention adjusted for sex and age. Results: The mean age at assessment was 8.5 years at baseline and 13.7 years at follow-up, respectively. Incident SDB was more common in boys (odds ratio [OR] = 3.93, P = .008, confidence interval [CI] = 1.41-10.90). Children with prevalent SDB were more likely to be boys (OR = 2.48, P = .006) and had a greater increase in body mass index percentile change (OR 1.01, P = .034). Children with prevalent SDB also had 3.41 greater odds for development of obesity from baseline to follow-up in comparison with children with prevalent NoSDB. Conclusions: Adolescent boys are more likely to have persistent and incident SDB than girls. Children with prevalent SDB are more likely to have development of obesity. These risks are similar to those observed in adults. © 2010 Mosby, Inc. All rights reserved.
• Lundy, S. M., Silva, G. E., Kaemingk, K. L., Goodwin, J. L., & Quan, S. F. (2010). Cognitive Functioning and Academic Performance in Elementary School Children with Anxious/Depressed and Withdrawn Symptoms. The open pediatric medicine journal, 4, 1-9.
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  RATIONALE: Few studies have evaluated the relationship between depressive symptomatology and neuropsychological performance in children without symptomatic depression. OBJECTIVES: This study determined the relationship between anxious/depressed and withdrawn symptoms and performance on cognitive and academic achievement measures. METHODS: 335 Caucasian and Hispanic children aged 6 to 11 years who participated in the Tucson Children's Assessment of Sleep Apnea (TuCASA) study were administered a comprehensive neuropsychological battery measuring cognitive functioning and academic achievement. Their parents completed the Child Behavior Checklist (CBCL). Correlations between performance on the cognitive and academic achievement measures and two Internalizing scales from the CBCL were calculated. Comparisons were made between a "Clinical" referral group (using a T-score of ≥ 60 from the CBCL scales) and a "Normal" group, as well as between Caucasians and Hispanics. RESULTS: No differences were found between those participants with increased anxious/depressed or withdrawn symptoms on the CBCL and those without increased symptoms with respect to age, gender, ethnicity, or parental education level. However, significant negative correlations were found between these symptoms and general intellectual function, language, visual construction skills, attention, processing speed, executive functioning abilities, aspects of learning and memory, psychomotor speed and coordination, and basic academic skills. CONCLUSIONS: These findings support the hypothesis that depressive symptomatology negatively impacts performance on cognitive and academic achievement measures in school-aged children and these findings are not affected by ethnicity. The findings also reinforce the concept that the presence of anxious/depressed or withdrawn symptoms needs to be considered when evaluating poor neuropsychological performance in children.
• Silva, G. E., An, M., Goodwin, J. L., Shahar, E., Redline, S., Resnick, H., Baldwin, C. M., & Quan, S. F. (2009). Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: The Sleep Heart Health Study (SHHS). Sleep, 32(8), 1049-1057.
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  PMID: 19725256;PMCID: PMC2717195;Abstract: Study Objectives: Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time. Design: Prospective cohort study. Data were from the Sleep Heart Health Study. Setting: Multicenter study. Participants: Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included. Measurements: The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep. Results: Mean respiratory disturbance index increased from 8.1 ± 11 SD at baseline to 10.9 ± 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life. Conclusions: A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life.
• Sharief, I., Silva, G. E., Goodwin, J. L., & Quan, S. F. (2008). Effect of sleep disordered breathing on the sleep of bed partners in the sleep heart health study. Sleep, 31(10), 1449-1456.
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  PMID: 18853943;PMCID: PMC2572736;Abstract: Objective: To study the sleep quality of bed partners of persons with sleep disordered breathing in a non-clinical population based sample in a home environment. Design: Cross-sectional study in a community sample. Methods: 110 pairs of subjects living in the same household from the Tucson, Minnesota, and Pittsburgh sites of the Sleep Heart Health Study (SHHS) were included if both partners had an in-home, unattended polysomnogram (PSG) performed as a part of SHHS exam cycle 2. Sleep disordered breathing (SDB) was considered present if the respiratory disturbance index (RDI) was ≥10 events/h and no SDB if RDI was
• Silva, G. E., Guerra, S., Keim, S., Barbee, R. A., & Sherrill, D. L. (2008). Longitudinal decline of diffusing capacity of the lung for carbon monoxide in community subjects with the PiMZ α₁-antitrypsin phenotype. Chest, 133(5), 1095-1100.
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  PMID: 18263681;Abstract: Background: It is well known that homozygous deficiency of α2-antitrypsin, PiZZ, is associated with an increased risk of emphysema. However, studies evaluating associations between the heterozygous form PiMZ with emphysema and impaired lung function have provided conflicting results. Study objective: The goal of this study was to determine if the phenotype PiMZ is associated with an accelerated decline in diffusing capacity of the lung for carbon monoxide (DLCO). Design and methods: The Tucson Epidemiologic Study of Airway Obstructive Disease is a prospective, population-based cohort study initiated in 1972. Participants completed standardized questionnaires in up to 12 periodic surveys and DLCO assessments in up to 4 surveys. Random-effects models were used to determine the effects of α1-antitrypsin phenotypes on percentage of predicted (% predicted) DLCO levels among 1,075 subjects ≥ 18 years old. Results: % predicted DLCO declined more rapidly in subjects who smoked compared to nonsmoking subjects. Additionally, in smokers, the PiMZ phenotype was associated with borderline % predicted DLCO deficits at age 40 years (8.6%; p = 0.075) and significant % predicted DLCO deficits at age 60 years (15.2%; p = 0.001) and 80 years (21.9%; p = 0.003), as compared with the PiMM phenotype. Conclusions: DLCO may be a more sensitive indicator of the long-term effects of intermediate levels of α1-antitrypsin on lung function especially in subjects who smoke.
• Goodwin, J. L., Silva, G. E., Kaemingk, K. L., Sherrill, D. L., Morgan, W. J., & Quan, S. F. (2007). Comparison between reported and recorded total sleep time and sleep latency in 6- to 11-year-old children: The Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Sleep and Breathing, 11(2), 85-92.
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  PMID: 17165092;Abstract: Research comparing parental report of sleep times to objectively obtained polysomnographic evidence of sleep times in schoolchildren is lacking. This report compares habitual sleep time and objectively recorded sleep time and sleep latency with parental reports of sleep time immediately after a night of polysomnography in elementary schoolchildren. Unattended home polysomnograms (PSG) were obtained from 480 children. On the night of the PSG, a parent was asked to complete a Sleep Habits Questionnaire, which inquired about the habitual total sleep time (HABTST) and habitual sleep onset latency (HABSOL) of his/her child on both school days and nonschool days. On the morning after the PSG, the parent was asked to estimate the total sleep time (ESTTST) and sleep onset latency (ESTSOL) of his/her child on the night of the recording. Comparisons were made to actual total sleep time (PSGTST) and sleep latency (PSGSOL) on the PSG. The sample was comprised of 50% girls, 42.3% Hispanic, and 53% aged 6-8 years. The mean HABTST, ESTTST, and PSGTST were 578, 547, and 480 min, respectively. HABTST was greater than both ESTST and PSGTST (p
• Silva, G. E., Goodwin, J. L., Sherrill, D. L., Arnold, J. L., Bootzin, R. R., Smith, T., Walsleben, J. A., Baldwin, C. M., & Quan, S. F. (2007). Relationship between reported and measured sleep times: the sleep heart health study (SHHS). Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 3(6), 622-30.
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  Subjective and objective assessments of sleep may be discrepant due to sleep misperception and measurement effects, the latter of which may change the quality and quantity of a person's usual sleep. This study compared sleep times from polysomnography (PSG) with self-reports of habitual sleep and sleep estimated on the morning after a PSG in adults.
• Watson, R. R., Rohdewald, P., & Silva, G. E. (2007). Asthma risk factors in Desert Southwest of USA: Role of nutritional supplement, Pycnogenol® in therapy. Journal of Nutritional and Environmental Medicine, 16(1), 33-38.
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  Abstract: Purpose: Desert environments have some unique causative agents that promote asthma. These include molds like Alternaria alternata and Dermatophagoides farinae, and Bermuda grass pollen. In addition, dietary supplements with antioxidant activities are being shown to reduce asthma symptoms with Pycnogenol being the example used. Design: Literature review. Materials and methods: This review was conducted by searching PubMed and other medical databases, as well as doing original research reviewed. It was presented at the meeting of the British Society for Ecological Medicine in London, June 2006. Results: Recent studies are defining the risk factors for asthma induction in children in the desert environment of Southwest USA. In particular, exposure to molds and pets, maternal smoking, and being overweight. Two recent studies have shown that Pycnogenol, a dietary supplement containing bioflavanoids with strong antioxidant activity, reduced asthma symptoms in adults and youths. There was evidence that the extract lowered symptoms and reduced use of rescue inhalers. In addition, Pycnogenol reduced serum leukotrienes helping explain its action. Conclusions: Exposure to desert materials, in particular Alternaria alternata, increased risk of childhood asthma while Dermatophagoides farinae had no effect. Therapy was successful using a dietary supplement, Pycnogenol, containing bioflavanoids with strong antioxidant activities. © 2007 Informa UK Ltd.
• Silva, G. E., Sherrill, D. L., Guerra, S., & Barbee, R. A. (2004). Asthma as a risk factor for COPD in a longitudinal study. Chest, 126(1), 59-65.
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  PMID: 15249443;Abstract: Background: For several years, asthma and COPD have been regarded as distinct entities, with distinct clinical courses. However, despite distinctive physiologic features at the time of diagnosis, and different risk factors, the two diseases over time may develop features that are quite similar. Study objective: To evaluate the association between physician-diagnosed asthma and the subsequent development of COPD in a cohort of 3,099 adult subjects from Tucson, AZ. Design and methods: A prospective observational study. Participants completed up to 12 standard respiratory questionnaires and 11 spirometry lung function measurements over a period of 20 years. Survival curves (with time to development of COPD as the dependent variable) were compared between subjects with asthma and subjects without asthma at the initial survey. Results: Subjects with active asthma (n = 192) had significantly higher hazard ratios than inactive (n = 156) or nonasthmatic subjects (n = 2751) for acquiring COPD. As compared with nonasthmatics, active asthmatics had a 10-times-higher risk for acquiring symptoms of chronic bronchitis (95% confidence interval [CI], 4.94 to 20.25), 17-times-higher risk of receiving a diagnosis of emphysema (95% CI, 8.31 to 34.83), and 12.5-times-higher risk of fulfilling COPD criteria (95% CI, 6.84 to 22.84), even after adjusting for smoking history and other potential confounders. Conclusions: Physician-diagnosed asthma is significantly associated with an increased risk for CB, emphysema, and COPD.
• Silva, G. E., Sherrill, D. L., Guerra, S., & Barbee, R. A. (2003). A longitudinal study of alpha1-antitrypsin phenotypes and decline in FEV1 in a community population. Chest, 123(5), 1435-40.
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  It is well-known that the homozygous deficiency of alpha(1)-antitrypsin, phenotype PiZZ, is associated with an increased risk of COPD. However, studies evaluating the association between the heterozygous forms of the alpha(1)-antitrypsin phenotype PiMZ and rapid decline in lung function, both in patient and community populations, have yielded conflicting results.

Proceedings Publications

• Skulas-Ray, A. C., Glickenstein, D. A., Silva Torres, G. E., Mayer, C., Thomson, C. A., Rojo-Wissar, D. M., & Haynes, P. L. (2019, June). Longer Sleep Duration Precedes Greater Water Intake at Breakfast. In Sleep, 42, A72.
• Haynes, P. L., Haynes, P. L., Haynes, P. L., Haynes, P. L., Quan, S. F., Quan, S. F., Quan, S. F., Quan, S. F., Rojo-Wissar, D., Rojo-Wissar, D., Rojo-Wissar, D., Rojo-Wissar, D., Silva Torres, G. E., Silva Torres, G. E., Silva Torres, G. E., & Silva Torres, G. E. (2017, June). Sensitivity and Specificity of the Duke Structured Interview for Sleep Disorders to Assess Sleep Disordered Breathing. In Sleep, 40, A180.

Presentations

• Heslin, K. M., Muramoto, M. L., Silva Torres, G. E., & Loescher, L. J. (2020, October). Educating massage therapists to engage in skin cancer primary prevention conversations with clients. International Cancer Education Conference.. Virtual (COVID-19): American Association of Cancer Education.
• Butler, E. A., Glickenstein, D. A., Silva Torres, G. E., Quan, S. F., Thomson, C. A., & Haynes, P. L. (2019, Spring). Inconsistent Social Rhythms are Associated with Higher Waist Circumference Following Job Loss. Society of Behavioral Medicine annual meeting. Washington D.C.: Society of Behavioral Medicine.
• Shea, K. D., Silva Torres, G. E., & Evans, B. (2017, April). A BEST PRACTICE ASSESSMENT PROTOCOL FOR MOBILE TECHNOLOGY HOME VISITS. Annual Research Conference. Denver, CO: Western Institute of Nursing.

Poster Presentations

• Haynes, P. L., Quan, S. F., Quan, S. F., Haynes, P. L., Silva Torres, G. E., Sherrill, D. L., Sherrill, D. L., Silva Torres, G. E., Gengler, D., Gengler, D., Glickenstein, D. A., Glickenstein, D. A., Rojo-Wissar, D., Rojo-Wissar, D., Oliver, R., Oliver, R., Nair, U. S., Nair, U. S., Nair, U. S., , Nair, U. S., et al. (2017, March). High prevalence of over the counter sleep aid use among individuals who have experienced involuntary job loss. Society of Behavioral Medicine. San Diego, CA.