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@ARTICLE{Nager:286087,
      author       = {Nager, Ladina and Princip, Mary and Attanasio, Veronica and
                      Dörner, Marc and Guth, Lisa and Zirngast, Sina and Sila,
                      Rahel and Pazhenkottil, Aju P and Menzi, Anna and König,
                      Noelle and Zuccarella-Hackl, Claudia and von Känel, Roland},
      title        = {{S}leep is associated with posttraumatic stress symptom
                      severity in patients with an implantable
                      cardioverter-defibrillator depending on age.},
      journal      = {Scientific reports},
      volume       = {16},
      number       = {1},
      issn         = {2045-2322},
      address      = {[London]},
      publisher    = {Springer Nature},
      reportid     = {DZNE-2026-00383},
      pages        = {11869},
      year         = {2026},
      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 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.},
      keywords     = {Humans / Stress Disorders, Post-Traumatic: etiology /
                      Stress Disorders, Post-Traumatic: physiopathology /
                      Defibrillators, Implantable: psychology / Defibrillators,
                      Implantable: adverse effects / Male / Female / Middle Aged /
                      Aged / Sleep Wake Disorders / Severity of Illness Index /
                      Age Factors / Sleep: physiology / Adult / Risk Factors /
                      Sleep Quality / Age (Other) / Implantable
                      cardioverter-defibrillator (ICD) (Other) / Pittsburgh sleep
                      quality index (PSQI) (Other) / Posttraumatic stress disorder
                      (PTSD) (Other) / Sleep (Other)},
      cin          = {AG Schreiber},
      ddc          = {600},
      cid          = {I:(DE-2719)1310010},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41776314},
      pmc          = {pmc:PMC13066363},
      doi          = {10.1038/s41598-026-42430-1},
      url          = {https://pub.dzne.de/record/286087},
}