Sleep is associated with posttraumatic stress symptom severity in patients with an implantable cardioverter-defibrillator depending on age

Patients with implantable cardioverter-defibrillators (ICDs) are vulnerable to psychological distress, including posttraumatic stress disorder (PTSD). Impaired sleep is a hallmark of PTSD, and may also act as a risk factor that maintains or exacerbates PTSD, yet this relationship has not been examined in ICD recipients across different ages. We assessed 422 patients with ICD or cardiac resynchronisation therapy with defibrillator (CRT-D) who completed the Pittsburgh sleep quality index (PSQI) and post-traumatic diagnostic scale (PDS). 44.2% of patients showed impaired sleep (PSQI > 5). A multiple linear regression model showed that poorer sleep was associated with greater PTSD severity, and this association weakened with increasing age (interaction β = - 0.002, 95% CI [- 0.004, - 0.001], p = 0.008), indicating stronger effects in younger patients. Exploratory component analyses identified daytime dysfunction (β = 0.351, 95% CI [0.212, 0.490], p < 0.001) and sleep disturbance (β = 0.345, 95% CI [0.126, 0.564], p = 0.002) as the components most strongly linked to PTSD symptoms. These findings support that routine sleep screening is an important component of comprehensive ICD care, identifying clinically relevant sleep disturbance associated with PTSD symptom severity and underscoring sleep as a meaningful and modifiable treatment target.