Sleep Affects Posttraumatic Stress Symptom Severity in Patients with an Implantable Cardioverter-Defibrillator Depending on Age

Abstract Patients with implantable cardioverter-defibrillators (ICDs) are vulnerable to psychological distress, including posttraumatic stress disorder (PTSD). Impaired sleep is a hallmark of PTSD, and ageing modifies sleep architecture and stress responsivity. However, how sleep relates to PTSD in ICD patients, and whether age modulates this link, remains unknown. We examined 422 consecutive 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 sleep impairment predicted PTSD severity whereby this association weakened with increasing age (interaction β = −0.002, 95% CI [− 0.004, − 0.0004], p = .012), indicating stronger effects in younger patients. Exploratory component analyses identified daytime dysfunction (β = 0.340, 95% CI [0.203, 0.476], p < .001) and sleep disturbance (β = 0.349, 95% CI [0.136, 0.561], p = .001) as the PSQI components independently linked to PTSD symptoms. Our findings suggest that sleep quality may be a clinically relevant correlate of ICD-related PTSD, with the impact greatest in younger recipients. Sleep disturbances and daytime consequences of poor sleep could drive this association, underscoring the need for age-sensitive, sleep-focused interventions in ICD after-care.