The goal of this observational study is to learn about the long-term health of United States military service members who were injured during combat. The main questions it aims to examine are: * How does the severity of a combat injury impact 1) cardiovascular risk, 2) the sympathetic nervous system and arrhythmias, 3) blood pressure, and 4) sleep disorders? * Are self-reported mental health symptoms related to sympathetic nervous system hyperactivity, sleep disorders, and cardiovascular risk in combat-injured service members? This study will recruit from a sample of participants in another research study called the Wounded Warrior Recovery Project (WWRP) who 1) agreed to be contacted about future research studies and 2) have a record of a combat injury within the Injury Severity Score ranges required for this study. Participants will: * Provide demographic information and a medical history review * Visit a local laboratory for biometrics measurements and to provide blood and urine samples * Wear an ambulatory electrocardiogram monitor for 24 hours per day for seven consecutive days * Wear a home sleep test monitoring device for one night * Wear a blood pressure monitor for 24 consecutive hours on the day after the home sleep test At the end of the study, participants will be asked to mail back the home sleep test and blood pressure monitors. Prepaid package materials will be provided.
Study Type
OBSERVATIONAL
Enrollment
200
Uniformed Services University of the Health Sciences
Bethesda, Maryland, United States
Frequency of arrhythmias
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine the frequency of arrhythmias.
Time frame: 7 days of wear
Frequency of atrial fibrillation
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine the frequency of atrial fibrillation.
Time frame: 7 days of wear
Frequency of atrial flutter
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine the frequency of atrial flutter.
Time frame: 7 days of wear
Density of premature ventricular contractions (PVCs)
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine the density of PVCs (percentage of total heartbeats that are PVCs).
Time frame: 7 days of wear
Frequency of ventricular tachycardia
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine the frequency of ventricular tachycardia.
Time frame: 7 days of wear
Heart rate
Readings from a 24-hour ambulatory electrocardiogram (ECG) monitor will be used to determine heart rate.
Time frame: 7 days of wear
Standard deviation of beat-to-beat intervals (SDNN)
Standard deviation of beat-to-beat intervals (SDNN) is a heart rate variability (HRV) time domain measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
Root mean square of successive differences (RMSSD)
Root mean square of successive differences (RMSSD) is a heart rate variability (HRV) time domain measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
Low frequency power
Low frequency power (LF, 0.04 - 0.15 Hz) is a heart rate variability (HRV) frequency domain measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
High frequency power
High frequency power (HF, 0.15 - 0.4 Hz) is a heart rate variability (HRV) frequency domain measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
Log-transformed QT variance (logQTv)
Log-transformed QT variance (logQTv) s a QT variability (QTV) measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
Beat-to-beat QT variability index (QTVI)
Beat-to-beat QT variability index (QTVI) is a QT variability (QTV) measure that will be automatically calculated for each 5-min epoch of the 24-hour ambulatory electrocardiogram (ECG) recording.
Time frame: 7 days of wear
Presence of obstructive sleep apnea
The presence of comorbid obstructive sleep apnea and/or nocturnal hypoxemia, will be evaluated with a home sleep study test device (HST) worn during the second or third study day
Time frame: One night
Presence of nocturnal hypoxemia
The presence of comorbid obstructive sleep apnea and/or nocturnal hypoxemia, will be evaluated with a home sleep study test device (HST) worn during the second or third study day
Time frame: One night
24-hour ambulatory blood pressure monitor (ABPM)
Blood pressure (diastolic and systolic) will be assessed using a 24-hour ABPM worn during the 24-hour period following the HST.
Time frame: 24 hours
High sensitivity C-reactive protein (hs-CRP)
This inflammatory marker will be measured during laboratory testing.
Time frame: Baseline
Posttraumatic Stress Disorder Checklist for Diagnostic and Statistics Manual of Mental Disorder 5 (PCL-5)
The severity of Posttraumatic Stress Disorder (PTSD) symptoms will be assessed by the PCL-5 20-question survey. Total scores range from 0 - 80, with higher scores indicating greater PTSD symptom severity.
Time frame: Baseline
8-item Patient Health Questionnaire depression scale (PHQ-8)
The severity of depressive symptoms will be measured by the eight-question PHQ-8 survey. Total scores range from 0 - 24, with with higher scores indicating greater depressive symptom severity.
Time frame: Baseline
Brief Dissociative Experience Scale (DES-B)
Severity of dissociative experiences will be assessed using the 8-item DES-B survey. Total scores range from 0 - 32, with with higher scores indicating greater dissociative experience severity.
Time frame: Baseline
Pittsburgh Sleep Quality Index (PSQI)
Participant-reported sleep characteristics will be assessed using the 19-item Pittsburgh Sleep Quality Index (PSQI). Total scores range from 0 - 21, with higher scores indicating worse sleep quality.
Time frame: Baseline
Epworth Sleepiness Scale (ESS)
Participant-reported sleep characteristics will be assessed using the 8-item Epworth Sleepiness Scale (ESS). Total scores range from 0 - 24, with higher scores indicating increased daytime sleepiness.
Time frame: Baseline
Insomnia Severity Index (ISI)
Participant-reported sleep characteristics will be assessed using the 7-item Insomnia Severity Index (ISI). Total scores range from 0 - 28, with higher scores indicating increased insomnia symptoms.
Time frame: Baseline
Berlin Sleep Questionnaire
Participant-reported sleep characteristics will be assessed using the 11-item Berlin Sleep Questionnaire. Scores will be calculated to determine if participants are "High Risk" or "Low Risk" for sleep apnea.
Time frame: Baseline
Body Mass Index
Height and weight will be measured during laboratory visit and combined to report BMI in kg/m\^2.
Time frame: Baseline
Blood Pressure
Blood pressure (diastolic and systolic) will be recorded at the time of laboratory visit
Time frame: Baseline
Hemoglobin A1C (HBA1C)
This laboratory test will be used to assess overall health outcomes.
Time frame: Baseline
Alanine aminotransferase (ALT/SGPT)
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Albumin:globulin (A:G) ratio
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Albumin, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Alkaline phosphatase, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Aspartate aminotransferase (AST/SGOT)
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Bilirubin, total
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Blood urea nitrogen (BUN)
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Blood urea nitrogen (BUN):creatinine ratio
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Calcium, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Carbon dioxide, total
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Chloride, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Creatinine, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Estimated glomerular filtration rate (eGFR) calculation
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Globulin, total
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Glucose, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Potassium, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Protein, total, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Sodium, serum
This laboratory test will be measured as part of a comprehensive metabolic panel and will be used to assess overall health outcomes.
Time frame: Baseline
Cystatin C with estimated glomerular filtration rate (eGFR)
This laboratory test will be used to assess overall health outcomes.
Time frame: Baseline
Cholesterol, total
This laboratory test will be measured as part of a lipid panel and will be used to assess overall health outcomes.
Time frame: Baseline
High-density lipoprotein (HDL) cholesterol
This laboratory test will be measured as part of a lipid panel and will be used to assess overall health outcomes.
Time frame: Baseline
Low-density lipoprotein (LDL) cholesterol (calculation)
This laboratory test will be measured as part of a lipid panel and will be used to assess overall health outcomes.
Time frame: Baseline
Triglycerides
This laboratory test will be measured as part of a lipid panel and will be used to assess overall health outcomes.
Time frame: Baseline
Very low-density lipoprotein (VLDL) cholesterol (calculation)
This laboratory test will be measured as part of a lipid panel and will be used to assess overall health outcomes.
Time frame: Baseline
Albumin/creatinine ratio, random urine
This laboratory test will be used to assess overall health outcomes.
Time frame: Baseline
N-terminal pro b-type natriuretic peptide (NT-proBNP)
This laboratory test will be used to assess overall health outcomes.
Time frame: Baseline
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