ADVANCE-SLEEP: Sleep health after sustaining serious physical combat injuries and the impact on mental and physical health: a mixed-methods analysis on the ADVANCE study cohort

As a fundamental biological process, sleep is essential for the optimal functioning of nearly all bodily systems. It supports physical recovery, mental wellbeing, and everyday functioning, yet sleep problems are common and can have lasting effects on health. In military populations, the impact of sleep health on mental and physical health is increasingly recognised. For deployed personnel, sleep is disrupted by inhospitable environments, irregular schedules, operational demands, and combat-related physical and psychological injuries. Despite this, gaps remain in understanding sleep in UK Veterans who sustained serious combat-related physical injuries during deployment to Afghanistan. This PhD, nested within the ADVANCE longitudinal study, examines sleep health and its impact on mental and physical health in this cohort.

This PhD project aims to examine sleep health after sustaining serious physical combat injuries and the impact on physical and mental health outcomes within the ADVANCE study cohort.

This PhD includes three work packages.

• The first work package is a systematic review, which brings together existing research to examine how sleep relates to physical health in military personnel and Veterans who served in Iraq or Afghanistan.
• The second work package uses data from participants in the ADVANCE study, comparing UK personnel who sustained serious combat-related physical injuries during deployment to Afghanistan with a matched group who did not sustain such injuries. Sleep is measured using questionnaires completed at three timepoints, and activity monitors worn for nine days to provide objective data on sleep patterns. Analyses will examine how dimensions of sleep health change over time, whether injured participants show different sleep trajectories than uninjured participants, and whether sleep fragmentation is associated with poorer physical health outcomes.
• The third work package involves semi-structured interviews with ADVANCE participants who report poor sleep. Interviews explore subjective sleep experiences, causes and impact of poor sleep health, and unmet needs in service provision.

Findings from the three work packages will be brought together to better understand sleep health following serious combat injury and to inform clinical care and support for veterans.

This project seeks to address the following research questions: 

1. How do longitudinal trends in sleep health (including duration, quality, latency and maintenance) in UK military personnel who sustained serious physical combat injuries (amputation vs non-amputation) during deployment to Afghanistan compare to a frequency-matched group without such injuries (comparison group)?
2. How does objectively measured sleep health differ between the injured group vs the comparison group, and what is the association with physical health (including cardiometabolic and inflammatory) outcomes?
3. What are the subjective experiences of poor sleep (including difficulties with sleep initiation, maintenance, nightmares and quality) among UK ex-military personnel who deployed to Afghanistan?

The sample includes participants from the ADVANCE cohort study over three timepoints (T0-T2). Data has been collected from 1,145 participants at baseline (T0), 1,053 participants at follow-up 1 (T1), and over 900 participants at follow-up 2 (T2).