Dr Milena Pavlova: Prioritize Sleep Disorders in Patients With Epilepsy When Considering VBC

Milena Pavlova, MD, neurologist, and medical director of the sleep testing center at Brigham and Women’s Faulkner hospital, talks about the importance of treating underlying sleep disorders in patients with seizures, especially within a value-based care (VBC) model.

Poor sleep usually worsens seizures, says Milena Pavlova, MD, neurologist, and medical director of the sleep testing center at Brigham and Women’s Faulkner hospital.


What role does value-based care play in patients with epilepsy who have sleep disorders?

When it comes to value-based care, it really depends on how the measurement is done. Whether we are talking about value in the immediate setting, or value in the longer-term health of the patient. I would say the treatment of sleep disorders is important, both in the short-term and in the long-term setting. In terms of the short-term setting, poor sleep is now a very well recognized risk factor for car accidents. So, from that perspective, it's a big risk, although I'm not sure how well this is actually reflected into the models of pay for services. But in terms of the overall health, there is currently a massive amount of evidence that various sleep disorders tend to be culprits for worsening health, and what I'll be talking about is going to be the role of sleep apnea for patients with epilepsy. Sleep apnea specifically is a well-recognized risk factor for myocardial infarction. It's a risk factor for stroke, as you know, stroke leads to disability and a lot of health utilization. Various sleep disorders have been implicated in the pathogenesis of worsening of various disorders of cognition, they have a role in dementia, they have a role in mood disorders, and also epilepsy, and I'm going to be talking about this a little bit more in detail because poor sleep tends to worsen seizures, that's the bottom line. So, in a value-based model, the frequency of seizures should be balanced with treatment of any underlying sleep disorders.

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