Supporting Stroke Recovery Through the Glymphatic System: Joyce Lee-Iannotti, MD, FAAN, FAASM

WATCH TIME: 5 minutes

"We could do more to prevent people from showing up to the emergency department with stroke—sleep is not a luxury, it’s a form of brain detox."

Stroke is the second-highest cause of death worldwide and the main cause of long-term disability, with ischemic stroke accounting for the majority of cases. The glymphatic system is a newly discovered waste clearance system of the brain through promoting the exchange of cerebrospinal fluid and interstitial fluid, which consists of a brain-wide paravascular space. In recent years, the literature around the glymphatic system and stroke have expanded, with one recent study suggesting impaired glymphatic function contributes to brain edema formation after ischemic stroke, potentially affecting recovery and functional outcomes.¹

The glymphatic system was once again a major hot topic at the 2025 SLEEP Annual Meeting, held June 8-11 in Seattle, Washington. Several presentations, including one by Joyce Lee-Iannotti, MD, FAAN, FAASM, touched on the influence of this sleep-dependent waste clearance. In her presentation, Lee-Iannotti, a sleep and stroke neurologist at Barrow Neurological Institute, focused on how this system pertains to stroke, through pathophysiology or recovery, and what clinicians should understand about these connections.

During the meeting, NeurologyLive^® sat down with Lee-Iannotti to discuss her talk and the evolving literature around the glymphatic system and stroke. Lee-Iannotti, who also serves as division chief of the Petznick Stroke Center at Barrow, explained how lifestyle interventions–especially sleep quality–can enhance glymphatic function and lower stroke risk. In addition, she provided commentary on recent emerging evidence that post-stroke glymphatic impairment worsens outcomes, but that interventions like sleep positioning and managing sleep deprivation may boost glymphatic clearance, reduce neuroinflammation, and improve recovery, particularly in both hemorrhagic and ischemic stroke settings.

Click here for more SLEEP 2025 coverage.

REFERENCE
1. Zhu J, Mo J, Liu K, et al. Glymphatic System Impairment Contributes to the Formation of Brain Edema After Ischemic Stroke. Stroke. 2024;55(5). doi:10.1161/STROKEAHA.123.045941