ABSTRACT
PURPOSE: Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition with high mortality and morbidity. The role of anticoagulation in the treatment of SCST remains unclear because there is limited evidence to support this treatment. This study aims to explore (1) the association between anticoagulation administration and mortality of cavernous sinus thrombosis from sinusitis, and (2) the types and duration of anticoagulation used. METHODS: This review was undertaken and reported in accordance with PRISMA guidelines. We included the studies that reported individual data of adult patients (≥ 18 years) diagnosed with cavernous sinus thrombosis from sinusitis confirmed by objective methods with documented therapy and outcome. A systematic search carried out in Embase, Medline, Scopus, and CENTRAL by two reviewers up to Dec 2023. The quality was evaluated using tool proposed by Murad et al. The logistic regression analysis was employed to adjust the confounding factors. RESULTS: A total of 72 articles with 110 patients, were eligible for inclusion in our meta-analysis. There was a significant difference less mortality in the group that received anticoagulants (3.3 vs. 18%, p = 0.022). The adjusted odds ratio for mortality in the anticoagulant-given group is 0.067 (0.009, 0.475). Heparin is the most frequently used initial agent and one-third of patients receiving anticoagulants for three months. CONCLUSION: In an adult patient diagnosed with cavernous sinus thrombosis, there was a strong suggestion that anticoagulation could improve mortality. We recommend that patients with hyperglycemia should be carefully considered before receiving an anticoagulant.
ABSTRACT
Obstructive sleep apnea is the most common sleep-related breathing disorder. Repetitive episodes of the obstructive respiratory events lead to arousal, sleep fragmentation, and excessive daytime sleepiness. Orexin, also known as hypocretin, is one of the most important neurotransmitters responsible for sleep and arousal regulation. Deficiency of orexin has been shown to be involved in the pathogenesis of narcolepsy, which shares cardinal symptoms of sleep apnea and excessive daytime sleep with obstructive sleep apnea. However, the relationship between orexin and obstructive sleep apnea is not well defined. In this review, we summarize the current evidence, from in vitro, in vivo, and clinical data, regarding the association between orexin and obstructive sleep apnea. The effects of orexin on sleep apnea, as well as how the consequences of obstructive sleep apnea affect the orexin system function are also discussed. Additionally, the contrary findings are also included and discussed.