The Orexin System and Its Impact on the Autonomic Nervous and Cardiometabolic System in Post-Acute Sequelae of COVID-19, 2025, Ruhrländer et al

The Orexin System and Its Impact on the Autonomic Nervous and Cardiometabolic System in Post-Acute Sequelae of COVID-19

Jana Ruhrländer, Styliani Syntila, Elisabeth Schieffer, Bernhard Schieffe

[Line break added]

Abstract
Orexins (OXs) are critical for regulating circadian rhythms, arousal, appetite, energy metabolism, and electrolyte balance, affecting both the autonomic nervous system (ANS) and the cardiovascular system (CVS). Disruption of the OX system can result in symptoms similar to those observed in post-acute sequelae of COVID-19 (PASC).

This review emphasizes the adverse effects of OX dysregulation on autonomic and cardiometabolic functions in patients with PASC. Additionally, we highlight the potential of anti-OX therapies to provide neuroprotective, anti-inflammatory, and immunoregulatory benefits, offering hope for alleviating some of the debilitating symptoms associated with PASC.

Link | PDF (Biomedicines) [Open Access]

 

My daughter, who has ME has found that Daridorexant, the orexin (wakefulness) receptor inhibitor helpful for her sleep.
Her delayed sleep onset has come down to about an hour, from 2-3+ hrs.
Also, when she wakes, which happened frequently, she goes back to sleep much more quickly and seems much less easily disturbed by noises at night.

She does not wake feeling "refreshed", and still takes a couple of hours to come to, ie ready for conversations or getting ready to do something. However her cognitive processing is significantly better! (at least some of the time)

 

Interesting. I can’t notice a difference when taking Daxidorexant or not.

 

Her cognitive impairment was huge.
Prior to developing ME, after viral labyrihthitis, she had been studying Maths and other A levels.

She had 3 separate periods of improving after certain antibiotics. The first was twice weekly i/m injections of penicilin for c 8 weeks. Towards the end of this time she was able to take up the Maths again with a tutor and took the AS level. Sadly she got worse againafter about 4 months.
When I encouraged her to have a shorter, 30 mins session, when she wasn't experiencing improvement, her tutor said it was like teaching a different youngster. Things she had known inside out a few months earlier, she could not understand, let alone remember.

The rationale for these antibiotics wa a raised ASO titre (Anti Streptolysin O). This is a measure of a strep infection, hers was twice normal.

ETA: correcting typos