Dr Milena Pavlova Emphasizes the Importance of Sleep Apnea Treatment in Epilepsy

Milena Pavlova, MD, neurologist, and medical director of the Sleep Testing Center at Brigham and Women’s Faulkner Hospital, highlights how even mild cases of sleep apnea can increase the number of seizures a patient with epilepsy experiences and harm organs.

Sleep conditions like sleep apnea, even mild cases, can escalate the number of seizures a patient with epilepsy experiences and injure organs due to oxygen deprivation, says Milena Pavlova, MD, neurologist, and medical director of the Sleep Testing Center at Brigham and Women’s Faulkner Hospital.

*This interview took place at the American Academy of Neurology 75th annual meeting in Boston


What kinds of complications do you see in patients that have epilepsy and untreated sleep disorders?

It really depends on the sleep disorder. Probably the most glaring example is sleep apnea; patients not breathing well during sleep and waking up to breathe. Virtually anything that has a blood vessel gets worse from sleep apnea, because sleep apnea leads to lower oxygen level intermittently and that is harmful to the wall of the blood vessels. So, anything that has a blood vessel, whether it's the brain, heart, or any peripheral organ, it gets worse. When it comes to things that have to do with attention, cognition, and mood, this process of multiple times per hour waking up to breathe leads to poor sleep.

Poor sleep tends to worsen these disorders in multiple different ways. The easiest way to measure is frequency of seizures. It is now a recognized factor that can contribute to more frequent seizures; there has been research on this. One of the studies I will be citing is particularly interesting because they looked at seizures after the age of 50. And they divided the patients in 2 groups: One had patients who had well-controlled seizures, meaning they are taking their medications and their seizures have stopped happening, and the other group was patients who had either new onset of seizures or more frequent seizures after the age of 50. They found that those who have more frequent seizures have a much higher frequency of sleep apnea. It wasn't even necessarily severe sleep apnea—some of them had mild sleep apnea— but sufficient to worsen sleep and for the patient to have more frequent seizures.

I will be also talking about a couple of other studies that have been more recent that have examined whether treatment of sleep apnea can help improve the control of seizures. They have a very similar bottom line. People who are treated for sleep apnea and adherence to the treatment—meaning they are using the treatment that was tested with CPAP [continuous positive airway pressure] treatment, the first line therapy for sleep apnea—in both of these studies, the patients who were using more consistently the CPAP machine had a reduction in the number of their seizures, and in both studies, more than half of the patients became seizure free. So, a very, very striking example of the importance of treating sleep disorders in patients who have epilepsy.

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