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A large body of evidence has documented the impact of the global COVID-19 outbreak - and especially the lockdown period - on sleep quality and quantity. Here, we present the first Italian longitudinal study on sleep and COVID-19 considering four different time points collected during lockdown (from 29 March 2020 to 3 May 2020) and a subsequent follow-up period (October 2020). We used an online survey to collect socio-demographic and COVID-19 related information. Subjects were also asked to complete a sleep diary at each time point of the study. Our longitudinal sample included 147 participants. Statistical comparison across time intervals showed remarkable changes in sleep patterns during and after the lockdown. In particular, during lockdown we observed longer sleep latency, less ease of falling asleep, a higher total bedtime, and a lower dream frequency. The week-by-week evaluation described relatively stable patterns in the observed measures during the lockdown period, except for dream frequency, affected by a rapid increase in the early phase of lockdown. Our findings are in line with the current literature. Furthermore, the prospective longitudinal investigation comprising several time points offered the possibility of (a) observing the temporal dynamics and the different entities of such changes over time, and (b) reducing the typical memory bias for these studies., (© 2021 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Importance: The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established., Objective: To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts., Design, Setting, and Participants: Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020., Exposures: Participants were working either forward- or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction., Main Outcomes and Measures: Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale., Results: A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F1,139 = 41.23; P < .001) and cognitive slowing (ie, longer median reaction times; F1,139 = 42.12; P < .001) than those working forward rotations. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score ≥7) after the night shift. The median reaction time (F1,139 = 42.12; P < .001), 10% fastest reaction time (F1,139 = 97.07; P < .001), minor lapses (F1,139 = 46.29; P < .001), and reaction time distribution (F1,139 = 60.13; P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance., Conclusions and Relevance: In this study, both shift rotation models were negatively associated with health and cognitive performance. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentional outcomes and sleepiness. Optimization of shift rotations should be implemented to decrease the combination of the negative outcomes associated with shift work and reduce the potential risk of medical errors in health care systems.

Objective: The lockdown due to COVID-19 pandemic had a strong impact on daily habits, emotional experience, mental health and sleep. A large body of evidence suggests that dreams are affected by both waking experiences and sleep pattern. In this view, the lockdown should have induced intense modifications in dreaming activity. The aim of the study was to assess dream features during the lockdown in Italy., Methods: We used an online survey to collect self-reported demographic, clinical, sleep and dream data. Our sample included 1091 participants., Results: Results point to an increased dream frequency, emotional load, vividness, bizarreness and length during the lockdown, compared to a pre-lockdown period. Higher dream frequency and specific qualitative features were found in females and subjects with poor sleep quality, nocturnal disruptive behaviours and depressive symptoms. Most of the dream features assessed during the lockdown were predicted by age, gender, depressive symptoms, presence/absence of other people at home, and territorial area. A specific focus on sleep features revealed that sleep duration and several sleep quality indexes were the best predictors of dream variables. During the lockdown, dreams were also characterized by increased negative emotions, which were particularly frequent in females, younger adults, and participants with poor sleep quality, nocturnal disruptive behaviours, anxiety and depressive symptoms., Conclusions: Our results confirm the hypothesis of a strong influence of the pandemic on dreaming, supporting both the hypothesis of continuity between wake and sleep mental processes and the view of a crucial influence of sleep quality and duration on dreaming activity., (Copyright © 2021 Elsevier B.V. All rights reserved.)