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Awareness of performance deficits and errors during sleep loss could be protective against the consequences of sleep deprivation, however, it is unclear whether sleep deprived individuals have insight into their performance. We conducted a systematic review and meta-analysis of the impact of sleep loss (sleep duration <6 h) on monitoring of performance and errors using Embase, MEDLINE, PsycINFO & Cochrane Central. We identified 28 studies, 11 of which were appropriate for meta-analysis. The systematic review indicated limited consensus regarding sleep loss impacts on performance monitoring, due to substantial differences in study methodology. However, participants typically demonstrated more conservative estimates of performance during sleep loss. Error-monitoring literature was more consistent, indicating an impairment in error-monitoring following sleep loss. Meta-analyses supported the findings of the systematic review. In terms of methodology, we found the performance monitoring literature is limited by an overreliance on correlational designs, which are likely confounded by response bias. The error-monitoring literature is limited by very few studies utilising behavioural measures to directly measure error-awareness. Future performance monitoring studies must employ methods which control for confounds such as bias, and error-monitoring studies must incorporate combined behavioural and ERP measures to better understand the impact of sleep loss on error-monitoring. [ABSTRACT FROM AUTHOR]

Orexin receptor antagonists are a relatively new hypnotic principle. Their influence on human sleep architecture is a point of debate that has not been systematically evaluated. Thus, we performed a systematic review to assess how these compounds effect sleep architecture in healthy and clinical human samples. Relevant articles were identified via searches of PubMed, Embase, the Cochrane central register of controlled trials, and clinicaltrials. gov. From 1147 retrieved records, 18 satisfied inclusion criteria and formed the basis of this review. Of these, fifteen studies administered dual orexin receptor antagonists (DORA) in a healthy control (five studies) or clinical sample (ten studies). By contrast, three studies administered selective orexin receptor-2 antagonists (2-SORA) in either a healthy control (one study) or clinical sample (two studies). Results reveal DORAs increase total sleep time primarily by promoting REM sleep, without affecting, or even decreasing, non-REM sleep, especially in clinical samples. Therefore, the clinical utility of DORAs may depend on the specific sample being treated. For 2-SORAs, limited evidence available precludes firm conclusions about their influence on human sleep architecture and, thus, further investigation of 2-SORAs is required to define their effects and make comparisons on this basis with DORAs. [ABSTRACT FROM AUTHOR]

• Light-dark shifts disrupt patterns of locomotor activity. • Light-dark shifts heighten fear and decrease fear extinction consolidation. • Light-dark shifts impair fear suppression to safety cues. Animal models of fear conditioning and fear inhibition are frequently employed in the study of associative learning and commonly derive important human implications. Animal and human studies have demonstrated fear processing abilities are moderated by circadian rhythms, however, the influence of circadian disruption on fear inhibition is not well understood. Here, we examined the effects of circadian disruption on fear inhibition processes (i.e., fear extinction and safety learning) in a pre-clinical model. Adult male C57Bl/6 J mice completed cued fear and safety conditioning in the active phase before undergoing acute shifts in the Light-Dark (LD) cycle. Specifically, the light-phase was advanced by eight-hours across a one-day period (Experiment 1) or a two-day period (Experiment 2), before returning to original timing. Fear and safety recall were assessed over two days following LD shifts. Control groups maintained one LD cycle throughout both experiments. In both experiments, mice allocated to LD shifted groups revealed misaligned patterns of previously circadian locomotor activity. In the second recall session of Experiment 1, LD shifted mice demonstrated reduced retention of conditioned safety memory. However, in Experiment 2, LD shifted mice displayed heightened fear across conditioned fear cues in both recall sessions, therefore demonstrating consistent fear extinction impairment. Moreover, in recall session two, these mice revealed impaired ability to suppress fear during initial presentations of fear and safety cues. Overall, our data suggest maintaining a consistent LD cycle may be crucially important to individuals at high-risk of trauma-exposure and subsequent development of posttraumatic stress disorder. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis (PROSPERO registration animal/human studies: CRD42021234793/CRD42021234790) examined the relationship between sleep and appetitive conditioning. Inclusion criteria included: a) appetitive conditioning paradigm; b) measure of conditioning; c) sleep measurement and/or sleep loss; d) human and/etor non-human animal samples; and e) written in English. Searches of seven databases returned 3777 publications. The final sample consisted of 42 studies using primarily animal samples and involving food- and drug-related conditioning tasks. We found sleep loss disrupted appetitive conditioning of food rewards (p < 0.001) but potentiated appetitive conditioning of drug rewards (p < 0.001). Furthermore, sleep loss negatively impacted extinction learning irrespective of the reward type. Post-learning sleep was associated with increases in REM sleep (p = 0.02). Findings suggest sleep loss potentiates the impact of psychoactive substances in a manner likely to produce an increased risk of problematic substance use. In obese/overweight populations, sleep loss may be associated with deficits in the conditioning and extinction of reward-related behaviours. Further research should assess the relationship between sleep and appetitive conditioning in humans. • Sleep is an overlooked mechanism underpinning maladaptive appetitive conditioning. • This review examined the relationship between sleep and appetitive conditioning. • Sleep loss disrupts food-related, but potentiates drug-related, reward conditioning. • Post-learning increases in REM sleep are associated with improved task performance. [ABSTRACT FROM AUTHOR]

Background: The intubating laryngeal mask airway (ILMA) is an extraglottic device with a high rate of successful ventilation and oxygenation. Most modern airway algorithms suggest using an extraglottic device as the first-line rescue technique for a failed airway in emergency airway management. Eventually, a more secure airway is needed if the extraglottic temporizing device is working well. Retrograde intubation is a surgical airway management technique that is effective but relatively slow, making it most useful when ventilation can be maintained during the procedure.Case Report: We report 2 cases of difficult emergency airway management with an ILMA used initially and retrograde intubation later used to establish a more secure airway. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Retrograde incubation can be performed with an LMA in place for complicated airway management. [ABSTRACT FROM AUTHOR]