Exploring the bidirectional relationship between disorders of arousal and stress. An observational epidemiological study in a large population of university students.

INTRODUCTION: Disorders of Arousal (DoA) are NREM parasomnias, encompassing three main clinical manifestations: sleepwalking (SW), confusional arousals (CA), and sleep terrors (ST). Clinical evidence suggests a bidirectional relationship between stress and DoA, wherein stress exacerbates DoA episodes, and the episodes themselves may contribute to psychological stress, impacting quality of life. The aim of our study was to evaluate the prevalence of SW, ST and CA and their relationship with subjective perception of distress within a large university population. METHODS: A web-based survey was conducted among students aged 18 to 35 at Bicocca University of Milan between May and June 2023. The survey collected data on sociodemographic characteristics and lifestyle habits, along with responses to two validated Italian questionnaires: the Arousal Disorder Questionnaire (ADQ), used to assess the occurrence of DoA (1), and the General Health Questionnaire (GHQ-12), a widely utilized tool for measuring current psychological distress (2). RESULTS: A total of 1049 students completed the survey, with a median age of 23.0 years (IQR: 21.0-25.0). The prevalence of SW, ST, and CA was 2.7%, 3.0%, and 5.9%, respectively. The overall GHQ score was 6.0 (IQR: 5.0 - 8.0). Comparing subjects with or without DoA, perceived distress was significantly higher in individuals with ST (aOR = 1.25, 95% CI:1.06-1.47) and CA (aOR = 1.19, 95% CI:1.07-1.33), whereas no significant differences were observed for SW. CONCLUSIONS: These findings align with prevalence rates reported in other adult populations and support an association between DoA and stress. Further longitudinal studies are warranted to clarify the direction of this relationship and to explore whether psychological interventions may have a role in the management of DoA.