Skip to main content

Central precocious puberty during COVID-19 pandemic and sleep disturbance: an exploratory study



Increased incidence of central precocious puberty (CPP) after coronavirus infectious disease-19 lockdown has been reported. Our study aims in investigating changes in CPP rates and in sleep patterns in CPP and healthy controls.


CPP were retrospectively evaluated from April 2020 to April 2021. Parents of girls diagnosed with CPP during lockdown and of matched healthy controls filled out a questionnaire about sleep disturbances (SDSC questionnaire) and sleep schedules.


Thirty-five CPP and 37 controls completed the survey. Incidence of new CPP cases significantly increased in 2020–2021 compared to 2017–2020 (5:100 vs 2:100, p = 0.02). Sleep disturbance rates did not differ between CPP and healthy controls before lockdown. During lockdown, CPP reported higher rates of sleep disturbs for total score (p = 0.005), excessive somnolence (p = 0.049), sleep breathing disorders (p = 0.049), and sleep–wake transition disorders (p = 0.005). Moreover, CPP group more frequently shifted toward later bedtime (p = 0.03) during lockdown compared to controls. Hours of sleep and smartphone exposure around bedtime did not differ between groups.


Our study confirms the observation of increased incidence of CPP after lockdown measures. Additionally, CPP showed higher rates of sleep disturbances and later bedtime compared to controls. The causality link between sleep disturbances and CPP should be further investigated to gain knowledge in this association.


On January 2020, a new severe acute respiratory syndrome (SARS) due to a previously unknown coronavirus infection was firstly reported in China [1]. Since then, the diffusion of the so-called COVID-19 (coronavirus infectious disease-19) has reached pandemic proportion.

With the aim of containing the spread of COVID-19, several Governments have imposed restrictive policies promoting social isolation and “stay at home”. National lockdowns lead to sudden and radical changes in social interactions and in study and working conditions. Italian government declared national lockdown on March 10th, 2020, since then people were forced to stay at home, and children dramatically changed their lifestyle for several months. In addition to national closures, Campania region imposed more severe restrictions and longer lockdown periods (March 2020 to May 2020 and November 2020 to April 2021). Given that, significant changes in lifestyle habits have been reported in children and adolescents. It has been registered an increase in sedentary behavior, junk food and sugar sweetened beverage intake, and sleep–wake rhythm dysregulation [2, 3]. Moreover, during the last months, scientific evidence has been produced about indirect consequences of lock-down and lifestyle habits modifications on children’s wellbeing. A significant and rapid raise of precocious puberty has been reported in Italy compared to past years [4, 5]. Puberty is known to be a complex phenomenon that is influenced by genetic, metabolic, psychological, and environmental factors. The mechanisms underlying puberty timing have not been completely clarified as several hormones and systems are involved [6]. Among them, melatonin has been proposed as one of neuromodulator of puberty onset [7,8,9]. Melatonin is secreted by pineal gland, and it is mainly involved in sleep–wake cycle regulation. However, it also influences hypothalamic-pituitary–gonadal axis maturation [10].

Based on this evidence, our study aims were: 1- to evaluate the changes in precocious puberty rates during lockdown in our tertiary centre of paediatric endocrinology in South Italy (where confinement measures and school closure were more severe compared to other Italian regions); 2- to investigate the differences in sleep habits and disturbances in girls with central precocious puberty compared to healthy controls.



We prospectively enrolled female patients that attended the outpatient clinic of paediatric endocrinology of the University of Campania Luigi Vanvitelli because of central precocious puberty (CPP) during the lockdown period (April 2020 to April 2021). Their clinical and biochemical data and CPP incidence were compared to those of the previous 3 years (2017–2020). CPP was defined as breast development before 8 years of age and by central hypothalamic–pituitary–gonadal activation identified by pubertal basal luteinizing hormone (LH) levels (LH > 0.3 UI/L) and/or GnRH-stimulated (0.1 mg Relefact LHRH; Sanofi-Aventis, Frankfurt am Main, Germany) LH levels > 5 IU/L [11, 12]. Magnetic resonance imaging of the central nervous system was normal in all patients. Additionally, we enrolled matched prepubertal healthy girls as control group. Control subjects were recruited from outpatient clinics for auxological evaluation in the same period and selected if growth parameters were in the normal range for age and sex. Girls with chronic diseases and assuming drugs affecting sleep/wake rhythm were excluded. Clinical examination was performed in all girls, including weight and height measurement, z-score BMI calculation using the LMS method and staging of breast development according to Tanner’s classification [13, 14].

The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the ethical committee of the University of Campania (Protocol number 23.26–20,200,008,943), and informed consent was obtained from the parents or guardians.

Diagnostic work-up

Chemiluminescence assay (LIAISON, Diasorin) was used to measure Follicle Stimulating Hormone (FSH) and LH concentrations, with detection limits of 0.06 and 0.05 U/L, respectively, and intra- and inter-assay CV less than 5%. Radioimmunoassay was used to measure serum estradiol (CisBio International). The analytical and functional detection limits for plasma estradiol were 4 and 8 pg/mL, respectively.

GnRH stimulation test was provided for patients in which basal hormone level did not meet diagnostic criteria for CPP. Peak-LH > 5UI/L after administration of 0.1 mg of Relefact LH-RH (Sanofi-Aventis, Frankfurt am Main, Germany) was considered positive.

Bone age was estimated according to Tanner-Whitehouse 2 (TW2) method.

Thin-section, contrast-enhanced MRI examination of sellar region with T1-weighted and T2 weighted sagittal, coronal sequences, 3DT2 thin section axial sequence and FLAIR and EPI DWI on axial sequence was acquired for all patients.

Sleep habits measures

Sleep disturbs were investigated by SDSC (sleep disturbance scale for children) questionnaire. This questionnaire has been validated in Italian school aged children and adolescents by Bruni et al. in 1996 [15]. The questionnaire comprehends 26 items scored in a 5-point Likert scale according to disturb frequency. The 26 items could be grouped in six subscales, namely: disorders of initiating and maintaining sleep (DIMS); sleep breathing disorders (SBD); disorders of arousal (DOA); sleep wake transition disorders (SWTD); disorders of excessive somnolence (DES), and sleep hyperhidrosis (SH). Moreover, a total score of global disturb might be obtained by the sum of subscales scores. Recently, several studies have investigated sleep disturbs in children during lockdown by SDSC questionnaire [3, 16,17,18,19]. In addition to SDSC, we registered bedtime, hours of sleep, and use of smartphone around bedtime, use of electronic devices during the day and for e-learning was not investigated. Bedtime was grouped as: before 10.00 pm; 10.00–11.00 pm; 11.00 pm-00.00am; and after 00.00am. Caregivers were asked to answer the questionnaire about children sleep habits. Questionnaires were administered during lockdown period. In addition, they filled out a second questionnaire referred to sleep behavior before lockdown with the aim of investigate changes in behaviors between the two periods.

Statistical analysis

Continuous variables were checked for normality distribution by Shapiro–Wilk test. Differences in continuous variables were investigated by Student t-test and Mann–Whitney U test as appropriate. Differences in categorical variable were evaluated by Fisher exact test and Chi square test as appropriate. SDSC scores were defined as pathologic score if scores were total ≥ 71, DIMS ≥ 17, SBD ≥ 7, DOA ≥ 6, SWTD ≥ 14, DES ≥ 13, and SH ≥ 7 [15]. CPP incidence was calculated as the ratio of CPP diagnosis and number of outpatients visits a year. Continuous data are expressed as mean ± standard deviations (DS). Categorical data are reported as frequency. A p value < 0.05 was considered statistically significant. All analyses were performed with SAS University Edition software.


Central precocious puberty incidence

Thirty-five girls with CPP attended our endocrinologic outpatient clinic from April 2020 to April 2021. Retrospective survey revealed that during the previous three years we observed 34 girls with CPP (average of 11 case/year). The overall number of new cases in 2020–2021 was higher than those observed in 2017–2020. Moreover, CPP incidence rate was 2.5-fold higher in 2020–2021 (5:100) compared to 2017–2020 (2:100, p = 0.002). Characteristics of CPP diagnosed before lockdown and after/during lockdown are reported in Table 1. The two groups did not differ for age, DS-height, z-score BMI, familial history of precocious puberty, and peak-LH levels (Table 1). Conversely, we found significant higher levels of LH, FSH, and 17-beta estradiol in CPP after/during lockdown compared to those diagnosed before (Table 1).

Table 1 Clinical and biochemical characteristics of CPP cases diagnosed before and after lockdown measures

Central precocious puberty and sleep measures

A total of 72 parents (35 CPP and 37 controls) completed the survey. Girls with CPP were taller than controls (p = 0.002), whereas there were no differences for age (7.8 ± 0.7 versus 7.6 ± 0.9, p = 0.10), BMI (18.6 ± 3.3 versus 17.7 ± 3.6, p = 0.20), z-score BMI (1.1 ± 1.3 versus 0.7 ± 1.4, p = 0.22), and overweigh and obesity prevalence (34% versus 25%, p = 0.41) between groups.

Rates of pathologic SDSC scores did not significantly differ between the two groups for questionnaires referred to the period before lockdown. Conversely, we observed significant higher rates of altered score calculated for questionnaires during lockdown in CPP group compared to controls for total score (31.4% versus 5.3%, p = 0.005), DES (17.1% versus 2.6%, p = 0.049), SBD (17.1% versus 2.6%, p = 0.049), and SWTD (25.7% versus 2.63, p = 0.005). No differences were found for disorders in initiating and maintaining sleep (DIMS), disorders of arousal (DOA), and sleep hyperidrosis (SH) (see Fig. 1).

Fig. 1
figure 1

Distribution of pathologic scores according to groups. Star indicates significant differences. Legend: DIMS: disorders of initiating and maintaining sleep; SBD: sleep breathing disorders; DOA: disorders of arousal; SWTD: sleep wake transition disorders; DES: disorders of excessive somnolence; SH: sleep hyperhidrosis

With regards to bedtime, CPP group showed significant higher rates in shifting toward later bedtime during lockdown compared to controls (40.3% vs 17.7%, respectively, p = 0.03). However, total sleep hours did not significantly change before and during lockdown in both CPP and controls (p = 0.10 and p = 0.11, respectively). We also investigated electronic devices time exposure around bedtime and found no differences between the two groups (p = 0.23).


Our study confirms previous reports of increased CPP incidence rates during and after lockdown for COVID-19 in Italy [4, 5]. In our population, disease incidence more than doubled compared to the previous 3 years. Additionally, we found increased oestradiol, LH, and FSH levels in girls diagnosed after lockdown compared to previous years. This finding is in line to those reported by Stagi et al. that observed an acceleration of puberty progression in cases diagnosed after lockdown compared to the previous 5 years [4].

It is well known that puberty timing is influenced by both environmental and genetic factors. The dramatical changes in everyday routine that characterized lockdown period might have been a powerful trigger for puberty onset. However, the underlying mechanisms have not been elucidated and several hypotheses have been proposed, such as weight gain, psychological stress, and electronic devices overuse. In our sample we found no differences for electronic device use and adiposity measures between CPP and controls. Conversely, we observed higher prevalence of sleep disturbance and shift in later bedtime in CPP compared to control group. Main differences were observed for total disturbs score, sleep breathing disorders, sleep–wake transition disorders, and daily excessive somnolence.

The directionality of this association needs to be clarified. In fact, sexual steroids have been associated with changes in circadian rhythm in animal studies reporting later phase shift of daily rhythms in animals [20, 21]. However, these data have not been replicated in humans. Jessen et al. reported a correlation between 17OH-progesterone plasma level and bedtime in girls with premature pubarche. Nevertheless, no significant association were observed in girls with CPP [22]. Another study investigating the effect of oestrogens on sleep architecture in girls with CPP, failed to find any difference in sleep patterns in this group of patients before and after hormonal therapy, suggesting that oestrogens are not involved in sleep architecture regulation in this group of patients [23]. Therefore, more studies are needed to investigate whether sexual hormones might affect sleep homeostasis in humans, especially during puberty.

At the same time, it has been reported that changes in sleep hormones might influence puberty timing. In fact, melatonin plasma levels decrease has been associated with puberty onset in children [10, 24]. A study comparing melatonin plasma levels between precocious puberty (PP), normal puberty, and pre-pubertal girls, revealed that girls with PP had significantly lower melatonin levels compared to the other groups [25]. Whether melatonin directly inhibits the hypothalamus or reduces the pituitary response to GnRH should be further investigated. However, melatonin plasma levels physiologically decrease throughout growth; therefore, this reduction might allow the activation of the hypothalamus-pituitary-gland axis [24]. In our sample, girls with CPP showed higher rates of SBD and SWTD compared to controls. Sleep disturbances have been associated with lower levels of melatonin secretion and with melatonin secretion pattern disruption [26,27,28]. Therefore, it might be hypothesized that CPP group experienced a more severe melatonin plasma decrease compared to controls that could have acted as puberty trigger. Additionally, the age of this group is close to physiologic puberty onset, therefore melatonin reduction might enable the activity of an almost mature hypothalamic-pituitary-gonad axis [29].

On the other hand, sleep homeostasis is essential for cognitive and emotional development [30]. In fact, sleep disturbances have been associated with poor quality of life, impairment of everyday functioning, increased rate of mood and behavioral disorders [31,32,33] and impairment of academic performance [34,35,36]. Therefore, it is very important to recognize and treat sleep disruption. Considering our findings, girls with CPP might constitute a group of patients at higher risk of presenting sleep disorders and clinicians should be aware of this association and investigate the presence of sleep disturbances in this subgroup of patients. Therefore, we plan to extend our investigation to new CPP diagnosis even outside lockdown period aiming to eventually confirm this observation. Additionally, our exploratory findings might constitute the basis for new longitudinal studies investigating the mechanisms underlying the relationship between puberty and sleep homeostasis in larger cohorts.


In conclusion our study supports the observation of increased incidence of CPP after lockdown. Home confinement has significantly altered daily routine in children and adolescents and indirect health consequence of confinement are arising. In our sample, sleep disturbs are a frequent comorbidity in girls with CPP, and clinicians should be aware of this association. Further pathophysiologic studies are needed to investigate whether sleep alteration might be a trigger for puberty onset.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



Coronavirus Infectious Disease-19


Central Precocious Puberty


Disorders of Excessive Somnolence


Disorders of Initiating and Maintaining Sleep


Disorders of Arousal


Follicle Stimulating Hormone


Luteinizing Hormone


Severe Acute Respiratory Syndrome


Sleep Breathing Disorders


Sleep Disturbance Scale for Children


Sleep Hyperhidrosis


Sleep Wake Transition Disorders


  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382:727–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al. Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study. Obesity (Silver Spring). 2020;28:1382–5.

    Article  CAS  Google Scholar 

  3. Bruni O, Malorgio E, Doria M, Finotti E, Spruyt K, Melegari MG, et al. Changes in sleep patterns and disturbances in children and adolescents in Italy during the Covid-19 outbreak. Sleep Med. 2021.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stagi S, De Masi S, Bencini E, Losi S, Paci S, Parpagnoli M, et al. Increased incidence of precocious and accelerated puberty in females during and after the Italian lockdown for the coronavirus 2019 (COVID-19) pandemic. Ital J Pediatr. 2020;46:165.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Verzani M, Bizzarri C, Chioma L, Bottaro G, Pedicelli S, Cappa M. Impact of COVID-19 pandemic lockdown on early onset of puberty: experience of an Italian tertiary center". Ital J Pediatr. 2021;47:52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cheuiche AV, da Silveira LG, de Paula LCP, Lucena IRS, Silveiro SP. Diagnosis and management of precocious sexual maturation: an updated review. Eur J Pediatr. 2021.

    Article  PubMed  Google Scholar 

  7. Molina-Carballo A, Muñoz-Hoyos A, Martin-García JA, Uberos-Fernández J, Rodriguez-Cabezas T, Acuña-Castroviejo D. 5-Methoxytryptophol and melatonin in children: differences due to age and sex. J Pineal Res. 1996;21:73–9.

    Article  CAS  PubMed  Google Scholar 

  8. Waldhauser F, Steger H. Changes in melatonin secretion with age and pubescence. J Neural Transm Suppl. 1986;21:183–97.

    CAS  PubMed  Google Scholar 

  9. Gupta D. The pineal gland in relation to growth and development in children. J Neural Transm Suppl. 1986;21:217–32.

    CAS  PubMed  Google Scholar 

  10. Molina-Carballo A, Fernández-Tardáguila E, Uberos-Fernández J, Seiquer I, Contreras-Chova F, Muñoz-Hoyos A. Longitudinal study of the simultaneous secretion of melatonin and leptin during normal puberty. Horm Res. 2007;68:11–9.

    Article  CAS  PubMed  Google Scholar 

  11. Bangalore Krishna K, Fuqua JS, Rogol AD, Klein KO, Popovic J, Houk CP, et al. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res Paediatr. 2019;91(6):357–72.

    Article  CAS  PubMed  Google Scholar 

  12. Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995;127(1):47–52.

    Article  CAS  PubMed  Google Scholar 

  13. Cole TJ. Sample size and sample composition for constructing growth reference centiles. Stat Methods Med Res. 2021;30:488–507.

    Article  CAS  PubMed  Google Scholar 

  14. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child. 1976;51:170–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, et al. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5:251–61.

    Article  CAS  PubMed  Google Scholar 

  16. Dondi A, Fetta A, Lenzi J, Morigi F, Candela E, Rocca A, et al. Sleep disorders reveal distress among children and adolescents during the Covid-19 first wave: results of a large web-based Italian survey. Ital J Pediatr. 2021;47:130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lecuelle F, Leslie W, Huguelet S, Franco P, Putois B. Did the COVID-19 lockdown really have no impact on young children’s sleep? J Clin Sleep Med. 2020;16:2121.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dellagiulia A, Lionetti F, Fasolo M, Verderame C, Sperati A, Alessandri G. Early impact of COVID-19 lockdown on children’s sleep: a 4-week longitudinal study. J Clin Sleep Med. 2020;16:1639–40.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fidancı İ, Aksoy H, Yengil Taci D, Fidancı İ, Ayhan Başer D, Cankurtaran M. Evaluation of the effect of the COVID-19 pandemic on sleep disorders and nutrition in children. Int J Clin Pract. 2021;75: e14170.

    Article  CAS  PubMed  Google Scholar 

  20. Hagenauer MH, Ku JH, Lee TM. Chronotype changes during puberty depend on gonadal hormones in the slow-developing rodent. Octodon degus Horm Behav. 2011;60:37–45.

    Article  CAS  PubMed  Google Scholar 

  21. Hagenauer MH, King AF, Possidente B, McGinnis MY, Lumia AR, Peckham EM, et al. Changes in circadian rhythms during puberty in Rattus norvegicus: developmental time course and gonadal dependency. Horm Behav. 2011;60:46–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Jessen E, Vetter C, Roenneberg T, Liesenkötter K-P, Werner H, Jenni OG, et al. Sleep Timing in Patients with Precocious and Delayed Pubertal Development. Clocks & Sleep. 2019;1:140–50.

    Article  Google Scholar 

  23. McHill AW, Klerman EB, Slater B, Kangarloo T, Mankowski PW, Shaw ND. The relationship between estrogen and the decline in delta power during adolescence. Sleep. 2017;40:zsx008.

    Article  PubMed Central  Google Scholar 

  24. Brzezinski A. Melatonin in humans. N Engl J Med. 1997;336:186–95.

    Article  CAS  PubMed  Google Scholar 

  25. de Holanda FS, Tufik S, Bignotto M, Maganhin CG, Vieira LHL, Baracat EC, et al. Evaluation of melatonin on the precocious puberty: a pilot study. Gynecol Endocrinol. 2011;27:519–23.

    Article  CAS  PubMed  Google Scholar 

  26. Hernández C, Abreu J, Abreu P, Castro A, Jiménez A. Nocturnal melatonin plasma levels in patients with OSAS: the effect of CPAP. Eur Respir J. 2007;30:496–500.

    Article  CAS  PubMed  Google Scholar 

  27. Barnaś M, Maskey-Warzęchowska M, Bielicki P, Kumor M, Chazan R. Diurnal and nocturnal serum melatonin concentrations after treatment with continuous positive airway pressure in patients with obstructive sleep apnea. Pol Arch Intern Med. 2017;127:589–96.

    Article  PubMed  Google Scholar 

  28. Wyatt JK. Delayed sleep phase syndrome: pathophysiology and treatment options. Sleep. 2004;27:1195–203.

    Article  PubMed  Google Scholar 

  29. Courant F, Aksglaede L, Antignac J-P, Monteau F, Sorensen K, Andersson A-M, et al. Assessment of circulating sex steroid levels in prepubertal and pubertal boys and girls by a novel ultrasensitive gas chromatography-tandem mass spectrometry method. J Clin Endocrinol Metab. 2010;95:82–92.

    Article  CAS  PubMed  Google Scholar 

  30. O’Brien LM. The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18:813–23.

    Article  PubMed  Google Scholar 

  31. Biggs SN, Lushington K, van den Heuvel CJ, Martin AJ, Kennedy JD. Inconsistent sleep schedules and daytime behavioral difficulties in school-aged children. Sleep Med. 2011;12:780–6.

    Article  PubMed  Google Scholar 

  32. Gregory AM, Van der Ende J, Willis TA, Verhulst FC. Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life. Arch Pediatr Adolesc Med. 2008;162:330–5.

    Article  PubMed  Google Scholar 

  33. Hoedlmoser K, Kloesch G, Wiater A, Schabus M. Self-reported sleep patterns, sleep problems, and behavioral problems among school children aged 8–11 years. Somnologie (Berl). 2010;14:23–31.

    Article  CAS  Google Scholar 

  34. Short MA, Blunden S, Rigney G, Matricciani L, Coussens S, M Reynolds C, et al. Cognition and objectively measured sleep duration in children: a systematic review and meta-analysis. Sleep Health. 2018;4:292–300.

    Article  PubMed  Google Scholar 

  35. Li S, Arguelles L, Jiang F, Chen W, Jin X, Yan C, et al. Sleep, school performance, and a school-based intervention among school-aged children: a sleep series study in China. PLoS ONE. 2013;8: e67928.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Gruber R, Laviolette R, Deluca P, Monson E, Cornish K, Carrier J. Short sleep duration is associated with poor performance on IQ measures in healthy school-age children. Sleep Med. 2010;11:289–94.

    Article  PubMed  Google Scholar 

Download references


We are grateful to children and their families who gave consent to participate to the study. This work was supported by a grant (390) funded by “VALERE: VAnviteLli pEr la RicErca” program of University of Campania “L. Vanvitelli”.


No financial assistance was received in support of the study.

Author information

Authors and Affiliations



AG and EMDG conceived the study; GRU, IM and AF wrote manuscript draft; FL and SR performed data curation; AR, MG and CL performed patient enrollment; AG and EMDG revised the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Anna Grandone.

Ethics declarations

Ethics approval and consent to participate

The protocol was approved by the ethical committee of the University of Campania (Protocol number 23.26–20200008943).

Consent for publication

informed consent was obtained from children and parents enrolled in the study.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Umano, G.R., Maddaluno, I., Riccio, S. et al. Central precocious puberty during COVID-19 pandemic and sleep disturbance: an exploratory study. Ital J Pediatr 48, 60 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: