Key result
Sleep impairment is linked to ~16% worse PTSD symptoms per point in younger ICD patients.
Why the study?
Impaired sleep may maintain or exacerbate PTSD in patients with ICDs, but this relationship had not been examined across different ages.
Is global sleep impairment associated with PTSD symptom severity in patients with an ICD or CRT-D, and does this vary by age?
Cross-Sectional (n=422)
No
Is global sleep impairment associated with PTSD symptom severity in patients with an ICD or CRT-D, and does this vary by age?
Effect estimate: Interaction effect of PSQI × Age on PTSD severity β = -0.002, 95% CI [-0.004, -0.001], p = 0.008; PSQI main effect β = 0.119, 95% CI [0.095, 0.143], p < 0.001 (95% CI 95% CI [-0.004, -0.001] for interaction; 95% CI [0.095, 0.143] for PSQI main effect)
p-value: p=0.008 for interaction; <0.001 for PSQI main effect
Self-reported sleep impairment is significantly associated with greater PTSD symptom severity in ICD recipients, with the strongest effects observed in younger patients.
Supports sleep evaluation in younger ICD patients with PTSD; extends known association to this population with age-modified effects.
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.
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Nager et al. (2026) conducted a cross-sectional in Adult patients (mean age 57.7 years) with implantable cardioverter-defibrillators (ICD) or cardiac resynchronisation therapy with defibrillator (CRT-D) receiving routine follow-up care (n=422). Global sleep impairment assessed by Pittsburgh Sleep Quality Index (PSQI) vs. None; observational association between sleep impairment levels and PTSD symptom severity was evaluated on Posttraumatic stress disorder (PTSD) symptom severity measured by Posttraumatic Diagnostic Scale (PDS), excluding item related to sleep to avoid overlap (Interaction effect of PSQI × Age on PTSD severity β = -0.002, 95% CI [-0.004, -0.001], p = 0.008; PSQI main effect β = 0.119, 95% CI [0.095, 0.143], p < 0.001, 95% CI 95% CI [-0.004, -0.001] for interaction; 95% CI [0.095, 0.143] for PSQI main effect, p=0.008 for interaction; <0.001 for PSQI main effect). Global sleep impairment measured by PSQI was associated with increased PTSD symptom severity in ICD patients, with a significant interaction showing a 16% increase in PTSD symptoms per PSQI point at age 44, decreasing to 9% at age 72 (p = 0.008 for interaction).
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