Alterations In Sleep Architecture Across Major Neurological Disorders: A Systematic Review

Abstract

Sleep architecture, characterized by the cyclical alternation of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep stages, is fundamental to maintaining neurophysiological homeostasis, cognitive performance, and emotional regulation. In neurological disorders, alterations in sleep architecture are increasingly recognized as both a symptom and a contributing factor to disease progression. This systematic review synthesizes evidence from multiple databases to assess the impact of neurological disorders on sleep architecture, focusing on Alzheimer’s disease, Parkinson’s disease, epilepsy, multiple sclerosis, stroke, and other neuropsychiatric conditions. Findings reveal that Alzheimer’s disease is associated with reduced slow-wave sleep and fragmented REM sleep, whereas Parkinson’s disease often presents with REM sleep behavior disorder and sleep fragmentation. Epilepsy demonstrates interictal and postictal disruptions of NREM-REM balance, while multiple sclerosis is marked by insomnia, circadian rhythm disturbances, and increased sleep-disordered breathing. Stroke survivors frequently show alterations in REM density and reduced sleep efficiency, which negatively influence recovery outcomes. These abnormalities highlight the bidirectional link between neurological pathology and sleep, wherein disrupted sleep accelerates neurodegeneration and worsens functional outcomes. The review underscores the need for early recognition and management of sleep disorders in neurological populations, integration of polysomnographic evaluations into clinical practice, and development of targeted pharmacological and behavioral interventions. Furthermore, the findings emphasize the potential role of sleep architecture as a biomarker for disease progression and therapeutic response. By consolidating current evidence, this review provides a critical foundation for advancing personalized sleep medicine in neurological disorders and identifies research gaps warranting further exploration in longitudinal and mechanistic studies.