Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy

Objective: The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, andmany studies point to large modifications in several sleep and sleep-related domains. Nevertheless, presleeparousal during the pandemic has been substantially overlooked. Since hyperarousal represents oneof the main factors for the development and the perpetuation of chronic insomnia disorder, theassessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinicallyrelevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and presleeparousal in an Italian sample during the COVID-19 lockdown.Methods: We used an online survey to collect self-reported sociodemographic, environmental, clinical,sleep, and sleep-related data. Our final sample included 761 participants.Results: Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results showthat almost half of the sample suffered from clinically relevant levels of at least one component (ie,cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleepquality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal.Regarding the predictors of sleep and sleep-related measures, depressive and event-related stresssymptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components.Moreover, specific sociodemographic and environmental variables were uniquely related tosleep quality, cognitive or somatic pre-sleep arousal.Conclusions: These findings suggest that the assessment of specific sleep-related factors (ie, pre-sleeparousal), together with more global measures of sleep quality, may be crucial to depict the compleximpact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.