Impact of Living at the Japanese Antarctic Research Expedition Base on Urinary Status

How Sleep Research in Extreme Environments Can Inform the Military: Advocating for a Transactional Model of Sleep Adaptation

PURPOSE OF REVIEW

We review the literature on sleep in extreme environments. Accordingly, we present a model that identifies the need for mitigating interventions to preserve sleep quality for military deployments.

RECENT FINDINGS

Situational factors that affect sleep in extreme environments include cold temperatures, isolated and confined areas, fluctuating seasonality, photoperiodicity, and extreme latitudes and altitudes. Results vary across studies, but general effects include decreased total sleep time, poor sleep efficiency, and non-specific phase delays or phase advances in sleep onset and sleep architecture. Considering habitability measures (e.g., light or temperature control) and individual differences such as variable stress responses or sleep need can mitigate these effects to improve mood, cognition, and operational performance. Although the situational demands during military missions inevitably reduce total sleep time and sleep efficiency, mitigating factors can attenuate sleep-related impairments, hence allowing for optimal mission success and personnel safety.

Urological Emergencies and Diseases in Wilderness Expeditions

When considering medical emergencies that might affect an expedition, urologic emergencies are typically not included. However, the reality is that manageable and prevalent urologic disease processes can pose significant challenges for the wilderness medicine physician and warrant consideration. The purpose of this review is to identify and discuss the most commonly encountered urologic emergencies and diseases in the wilderness setting and to prepare the expedition medicine physician for management of these urgent conditions. A PubMed and Internet search for urologic emergencies and diseases in wilderness conditions was conducted. We also searched bibliographies for useful supplemental literature and material from leading mountain medicine and wilderness medicine societies as well as population-based studies for common urologic diseases. Urologic emergencies and diseases on expeditions and in wilderness conditions have been reported primarily with retrospective case series and case reports. The most commonly reported urologic emergencies in this setting include urologic trauma, renal calculi, and urinary retention. Parasitic infections in the urinary tract also have been reported to cause urinary symptoms and urinary retention in wilderness conditions. Although urologic diseases in such conditions are uncommon, significant morbidity and even potentially life-threatening sequelae to urologic emergencies were found to occur. Major genitourinary emergencies in expedition medicine are uncommon but involve both potentially manageable urgent conditions and serious life-threatening conditions best treated with urgent stabilization and occasionally medical evacuation. The opportunity exists for increased awareness for management strategies for urologic conditions in the often remote or extreme environments of an expedition.