Hein Zaw Myo, Che Mohd Nassir Che Mohd Nasril, Che Ramli Muhammad Danial, Jaffer Usman, Mehat Muhammad Zulfadli, Mustapha Muzaimi, Abdul Hamid Hafizah
Department of Basic Medical Sciences, College of Medicine, Ajman University, Ajman, United Arab Emirates.
Department of Anatomy and Physiology, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia.
J Cereb Blood Flow Metab. 2025 May 5:271678X251333933. doi: 10.1177/0271678X251333933.
The glymphatic system, a vital brain perivascular network for waste clearance, hinges on the functionality of the aquaporin 4 (AQP4) water channel. Alarmingly, AQP4 single nucleotide polymorphisms (SNPs) are linked to impaired glymphatic clearance, or glymphopathy, which contributes to sleep disturbances and various age-related neurodegenerative diseases. Despite the critical role of glymphopathy and sleep disturbances in cerebral small vessel disease (CSVD) - a silent precursor to age-related neurodegenerative disorders - their interplay remains underexplored. CSVD is a major cause of stroke and dementia, yet its pathogenesis is not fully understood. Emerging evidence implicates glymphopathy and sleep disorders as pivotal factors in age-related CSVD, exacerbating the condition by hindering waste removal and compromising blood-brain barrier (BBB) integrity. Advanced imaging techniques promise to enhance diagnosis and monitoring, while lifestyle modifications and personalised medicine present promising treatment avenues. This narrative review underscores the need for a multidisciplinary approach to understanding glymphopathy and sleep disorders in CSVD. By exploring their roles, emphasising the necessity for longitudinal studies, and discussing potential therapeutic interventions, this paper aims to pave the way for new research and therapeutic directions in CSVD management.
胶质淋巴系统是大脑中负责废物清除的重要血管周围网络，其依赖于水通道蛋白4（AQP4）水通道的功能。令人担忧的是，AQP4单核苷酸多态性（SNP）与胶质淋巴清除功能受损或胶质淋巴病有关，这会导致睡眠障碍和各种与年龄相关的神经退行性疾病。尽管胶质淋巴病和睡眠障碍在脑小血管疾病（CSVD）中起着关键作用，而CSVD是与年龄相关的神经退行性疾病的无症状先兆，但它们之间的相互作用仍未得到充分研究。CSVD是中风和痴呆的主要原因，但其发病机制尚未完全明确。新出现的证据表明，胶质淋巴病和睡眠障碍是与年龄相关的CSVD的关键因素，通过阻碍废物清除和损害血脑屏障（BBB）完整性而加重病情。先进的成像技术有望改善诊断和监测，而生活方式的改变和个性化医疗则提供了有前景的治疗途径。这篇叙述性综述强调了采用多学科方法来理解CSVD中的胶质淋巴病和睡眠障碍的必要性。通过探讨它们的作用、强调纵向研究的必要性以及讨论潜在的治疗干预措施，本文旨在为CSVD管理的新研究和治疗方向铺平道路。
