Milena Pavlova, MD, neurologist and medical director of the sleep testing center at Brigham and Women’s Faulkner Hospital, discusses the profound effect obstructive sleep apnea has on epilepsy as well as cognition.
Obstructive sleep apnea (OSA) worsens both epilepsy and cognitive function, says Milena Pavlova, MD, neurologist and medical director of the sleep testing center at Brigham and Women’s Faulkner Hospital.
What is the relationship between obstructive sleep apnea and epilepsy?
I would say it's bidirectional, but mostly in the direction of sleep apnea worsening epilepsy. It’s very straightforward in several ways: one is the hypoxemia and the fact that it overall worsens health, and then the other aspect is the frequent arousals because the patient needs to wake up to breathe. That is worsening the control of seizures as we discussed in the previous talk, it probably also leads to a lot of more complex changes within the human body that basically can favor both worse health, higher risk of cardiovascular, cerebrovascular disease, and various other things. Even more inflammatory changes that can have a further effect. Very simply, frequent arousals can increase the frequency of seizures. In the hospital when we try to record seizures for the purposes of surgical planning for example, we sleep deprive patients in order to facilitate recording of seizures. So, it is something that's has a fairly powerful effect. Sleep apnea worsens epilepsy, and worsens cognitive function actually, that's one of the slides. A few years ago, we looked at, specifically patients with untreated sleep apnea before the treatment of sleep apnea, who were diagnosed with sleep apnea and had epilepsy. They had a very strong correlation between the time spent under normal oxygen level. So, oxygen saturation level below 90% correlated with worse functioning, worse performance on the tests. So, the severity of sleep apnea also correlates with the cognitive functioning of epilepsy patients.