BREATHING EASY by mikesanye

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									           Dr. Aviv Goldbart                  Breathing Easy
Dr. Aviv Goldbart, pediatric                  well: neurobehavioral issues such as             But OSA in children? This was
pulmonologist, a sleep specialist at          hyperactivity or cognitive deficits. When    new. In order to learn more, Goldbart
the Soroka University Medical Center          they get older, many of them suffer from     headed to Louisville, Kentucky, to do
and a member of the Faculty of Health         daytime sleepiness and in general, suffer    his three-year post-doctoral research
Sciences, moved to Beer-Sheva at the          from poor daytime performance. I long        and clinical fellowship specializing
age of three and has lived in the region      suspected that these children were at risk   in pediatric respiratory diseases and
ever since. After studying medicine at        for complications later on in life, and I    sleep disorders in the Kosair Children’s
the Joyce and Irving Goldman School of        was determined to get to the root of the     Hospital and Research Institute – the
Medicine, he did his pediatric residency      problem.”                                    foremost pediatric sleep program at
at the Soroka University Medical                 Together with Tal, Goldbart,              the time. There, under the guidance of
Center. He also earned his Masters            incumbent of the Dr. Gabi and Eng.           Prof. David Gozal, he performed basic
degree as a health administrator at the       Max Lichtenberg Career Development           research on animals, depriving them of
University’s Department of Industrial         Chair in Pediatric Medicine, is              oxygen to simulate OSA, then closely
Engineering and Management. Goldbart          studying children who suffer from            studied the affected proteins and genes
is a researcher and a physician in the        sleep disordered breathing, which is         in their brains. Sure enough, the proteins
                                                                                           that are involved in cognitive and
                                                                                           behavioral functioning were adversely
                                                                                           affected due to the effects of insufficient
                               Whether at home with his family, at work in the             oxygen reaching the tissues. In one of
                               hospital or on summer vacation, Goldbart is surrounded      his studies, Goldbart demonstrated how        airways even though there was no sign       with OSA. In subsequent research,                Goldbart is married with four
                               by and helping children live healthier lives                junk food affects the brain in the same       of infection in the body. In short: those   Goldbart found that a medication called       daughters, two of them born in the
                                                                                           manner as OSA and also how, when the          children are at increased risk for health   montelukast (a leukotriene modifier)          United States, when he and his wife Riki
                                                                                           animals were exposed to both conditions       problems due to propagation of systemic     currently used for asthma, led to             were working in the Kosair Children’s
                                                                                           – lack of oxygen as well as junk food –       inflammation later on in life, just like    improved breathing during sleep and           Hospital.
Department of Pediatrics and is proud         more often known as “Obstructive             the animal’s brain was profoundly             adults with OSA, even though they           increased the size of the airway. “In            So are they a husband-wife doctor
to work in the new child-friendly Saban       Sleep Apnea” (OSA). OSA is a disorder        affected and it performed even worse in       may exhibit no clinical symptoms at all.    our study, parents gave their children        team? Goldbart laughs. “Not at all; I
Pediatric Medical Center recently             in which a person experiences many           intelligence-demanding tasks.                 Complications can include heart disease,    chewable tablets of montelukast at            did my fellowship in Louisville while
dedicated at the Soroka University            pauses of breathing while asleep, leading        Were children, even young children,       strokes, cardiovascular problems, obesity   night, before bedtime, instead of opting      my wife did her post-doctoral studies
Medical Center.                               to a low oxygen level in the blood (a        suffering similar effects, he asked?          and high blood pressure at a later age.     for surgery,” he explains. “It was well       there. Now both Riki and I are affiliated
   It was during his residency that           condition called hypoxia). Among             Goldbart says that as many as three               “Our goal is to find non-invasive       tolerated – and effective. But, of course,    with Ben-Gurion University; Riki
Goldbart came under the influence             adults, it has long been known that          percent of children suffer from OSA,          treatments for OSA,” continues              it will take a few more years until           works in the Department of Chemical
of Prof. Asher Tal, Head of Pediatrics        sleep apnea is a leading cause of daytime    compared to five percent of adults;           Goldbart. “Ideally, such treatment could    the drug is formally approved by the          Engineering. She is the “real” doctor
Department B and incumbent of the             sleepiness and road accidents and is an      among children, the main culprit              replace surgical adenotonsillectomy         American FDA for OSA use.”                    in the family – she has a Ph.D. in
Dr. Lillian Chutick and Dr. Rebecca           independent risk factor for high blood       is enlarged tonsils that block the            for children or the use of a CPAP               What are the remaining barriers           chemical engineering and biotechnology.
Chutick Chair in Pediatric Medicine,          pressure, stroke and several types of        breathing passage. Fortunately, the           compressed-air device for adults. We        to diagnosing and treating OSA in             Her research involves the controlled
whose research focuses on sleep-related       heart problems. Treatment for adults         relatively simple surgical procedure of       must remember that about 15 percent         children? “We do not have enough              release of drugs and genes, mainly via
pediatric illness. Goldbart became            involves diagnosing the condition in a       adenotonsillectomy, in which the tonsils      of children still suffer from OSA even      pediatric sleep labs to confirm the           ultrasound from an external source.”
fascinated by the riddle of children          special sleep-test (polysomnography) to      and adenoids are removed, corrects OSA        after adenotonsillectomy, and that any      condition,” Goldbart continues. “We only         Goldbart does volunteer work in
who suffer from frequent upper and            confirm that the patient is not getting      in about 75 percent of cases.                 surgery carries risks such as infection,    have four such clinics in Israel, and there   the scouts and helps Chaim Layeled, an
lower respiratory disorders. “Children        enough oxygen due to the pauses in               But the picture was more complicated      bleeding or dehydration. Also, many         are only 40 in the entire United States!”     organization for children with cystic
with enlarged tonsils and adenoids            breathing, then teaching him or her          than that. “We found that even in cases       adults cannot adapt to a CPAP machine.          Recently, the Israel Science              fibrosis, accompanying the children
tend to get sick two-and-a-half times         to use a special machine in which a          where there was no clear indication for       Non-invasive therapy for OSA would be       Foundation, in collaboration with the         to a summer camp in Europe as the
more frequently than other children           continuous stream of air under pressure      surgery – the tonsils were only slightly      a blessing.”                                Legacy Heritage Fund, awarded Goldbart        in-house doctor. So whether at home
their age; their parents are the ones         is delivered through a mask worn over        enlarged, for example – if children had           Goldbart’s research team uncovered      a significant grant for his research in       with his family, at work in the hospital
who are intimately familiar with the          the nose, or nose and mouth, to keep         OSA in the sleep lab, then they also had      how CRP, a marker for inflammation          inflammatory changes in young children        or on summer vacation, Goldbart is
doctor’s waiting room,” he says. “Often       the person’s airway open (typically          systemic (body-wide) inflammation.            in the blood, correlates with cardio-       with obstructive sleep apnea syndrome.        surrounded by and helping children live
these children have other problems as         called CPAP or BPAP) while he or she is      That means that we found markers of           vascular problems – identified by an        He was one of seven recipients chosen         healthier lives.
                                              sleeping.                                    inflammation in their blood, urine and        echocardiogram – in young children          from more than one hundred candidates.
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