Lusine Brsikian

Abstract: Sleep disorders are increasingly recognized as integral components of the clinical and pathophysiological spectrum of neurodegenerative diseases rather than secondary manifestations of neuronal decline. Converging evidence from recent high-quality studies indicates a bidirectional relationship, whereby neurodegenerative processes disrupt central sleep-wake regulatory networks, while chronic sleep impairment may exacerbate disease progression through mechanisms including impaired glymphatic clearance, pathological protein aggregation, neuroinflammation, and synaptic dysfunction. In Parkinson’s disease and related synucleinopathies, sleep disturbances – encompassing insomnia, excessive daytime sleepiness, circadian rhythm disruption, obstructive sleep apnea, restless legs syndrome, and rapid eye movement sleep behaviour disorder (RBD) – are highly prevalent. Notably, isolated RD is now established as a strong prodromal marker of -synucleinopathies. In Alzheimer’s disease and other dementias, reduced slow-wave sleep, sleep fragmentation, and circadian dysregulation have been consistently associated with impaired clearance of amyloid- and tau proteins, as well as accelerated cognitive decline. Comprehensive sleep phenotyping, integrating clinical evaluation with polysomnography, actigraphy, circadian biomarkers, and emerging fluid or seeding assays, offers significant potential for early diagnosis and prognostic stratification. Therapeutic approaches should be individualized and multimodal, incorporating optimization of disease-specific pharmacotherapy, targeted treatment of sleep-disordered breathing, circadian rhythm interventions, and pharmacological or behavioral management of insomnia and RBD. In conclusion, sleep disorders represent critical, potentially modifiable factors in neurodegenerative diseases, with growing relevance for early detection, risk stratification, and the development of disease-modifying therapeutic strategies.

Speaker: Lusine Brsikian works at the 5th Neurology Department with DNA Laboratory at Russian Center of Neurology and Neurosciences in Moscow. Her research interests include studying risk factors for dementia, particularly sleep disorders. She is currently conducting research as part of her PhD thesis to assess the role of sleep disturbances in Alzheimer's disease. She regularly participates in Russian and international conferences.