Sleep health in a bilingual European region: lessons from a population-based research programme in South Tyrol, Italy
Keywords:
sleep quality; health literacy; patient activation; adolescent mental health; prescribing patterns; South TyrolAbstract
Background. Sleep disorders are highly prevalent among European adults, with disease-specific estimates ranging from 10% for insomnia to 18% for obstructive sleep apnoea; however, sleep health remains underrepresented in national public health strategies. Population-based evidence on sleep quality and its broader determinants is scarce in Italy, where the only nationally representative survey was conducted in 2002. This narrative review synthesizes a coordinated sleep health research program in South Tyrol, a bilingual region in Northern Italy.
Methods. Six peer-reviewed publications (2025–2026) based on a representative adult survey (n = 2,090), adolescent mental health screening (n = 1,471), and regional pharmaceutical data were reviewed following the SANRA framework. Contextual literature was identified using PubMed and the Consensus academic search engine.
Results. Among adults, 18% met the criterion for poor sleep quality (B-PSQI ≥6), and 28% slept six hours or less. Latent profile analysis identified a Struggling Navigators cluster (25.8%) characterized by poor sleep, low health literacy, and elevated health care utilization. Mistrust of professional health information was independently associated with poor sleep and not mediated by health behaviors. Benzodiazepine consumption was approximately half the national average, offset by higher sedating antidepressant use, mirroring the German-language prescribing culture. Among adolescents, each additional hour of sleep reduced the odds of anxiety by 31% (OR = 0.69; 95% CI: 0.56–0.84) and depression in males by 40% (OR = 0.60; 95% CI: 0.44–0.81). Patient activation partially mediated the chronic disease–sleep relationship (4.7–6.3%) with disease-specific variation.
Discussion. The findings provide rare European population-based evidence on the health literacy–sleep and patient activation–sleep associations, introduce health information mistrust as a novel correlate of sleep quality, and document culturally shaped prescription patterns within a single national framework. The results support the integration of sleep into public health strategies and offer a replicable model for regional surveillance.
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Copyright (c) 2026 Dietmar Ausserhofer, Stefano Lombardo, Verena Barbieri, Giuliano Piccoliori, Doris Hager von Strobele Prainsack, Christian Josef Wiedermann (Author)
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