Clinical and Biofluid Biomarkers of Sleep Dysfunction in Parkinson's Disease

Parkinson's disease is a neurodegenerative disorder with an increasing prevalence worldwide. The development of disease-modifying therapies remains a critical priority; however, early intervention is limited by the paucity of robust biomarkers for the prodromal stage. Sleep disturbances-particularly isolated rapid eye movement sleep behavior disorder (iRBD)-are emerging as key clinical markers of prodromal synucleinopathy, offering opportunities for early detection and risk stratification. This article highlights advances in clinical and biofluid biomarkers, including speech abnormalities, α-synuclein seed amplification assays, dopa decarboxylase assays, and proteomic profiling in iRBD patients, which may enhance early diagnosis and patient selection for disease-modifying therapy trials.