title: Long-term impact of earthquakes on sleep quality.
abstract: OBJECTIVE
  We investigated the impact of the 6.3 magnitude 2009 L'Aquila (Italy) earthquake on standardized self-report measures of sleep quality (Pittsburgh Sleep Quality Index, PSQI) and frequency of disruptive nocturnal behaviours (Pittsburgh Sleep Quality Index-Addendum, PSQI-A) two years after the natural disaster.
  
  
  METHODS
  Self-reported sleep quality was assessed in 665 L'Aquila citizens exposed to the earthquake compared with a different sample (n = 754) of L'Aquila citizens tested 24 months before the earthquake. In addition, sleep quality and disruptive nocturnal behaviours (DNB) of people exposed to the traumatic experience were compared with people that in the same period lived in different areas ranging between 40 and 115 km from the earthquake epicenter (n = 3574).
  
  
  RESULTS
  The comparison between L'Aquila citizens before and after the earthquake showed a significant deterioration of sleep quality after the exposure to the trauma. In addition, two years after the earthquake L'Aquila citizens showed the highest PSQI scores and the highest incidence of DNB compared to subjects living in the surroundings. Interestingly, above-the-threshold PSQI scores were found in the participants living within 70 km from the epicenter, while trauma-related DNBs were found in people living in a range of 40 km. Multiple regressions confirmed that proximity to the epicenter is predictive of sleep disturbances and DNB, also suggesting a possible mediating effect of depression on PSQI scores.
  
  
  CONCLUSIONS
  The psychological effects of an earthquake may be much more pervasive and long-lasting of its building destruction, lasting for years and involving a much larger population. A reduced sleep quality and an increased frequency of DNB after two years may be a risk factor for the development of depression and posttraumatic stress disorder.
authors: Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
authors: Daniela
authors: D
authors: Tempesta
authors: Giuseppe
authors: G
authors: Curcio
authors: Luigi
authors: L
authors: De Gennaro
authors: Michele
authors: M
authors: Ferrara
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055866:Earthquakes; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012890:Sleep; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D014851:Wakefulness