Numerous buildings had collapsed in communities close to the epicentre of the quake near the town of Norcia in the region of Umbria, witnesses told Italian media, with an increase in the death toll highly likely.
The tremors were sufficiently strong to wake residents of central Rome, some 150 km away.
The first two confirmed victims were an elderly couple whose home collapsed in Pescara del Tronto in the Marche region, east of the epicentre, according to national broadcaster Rai.
"We have a tragedy here," Stefano Petrucci told Rai. "For the moment one death is confirmed but there are another four people under the rubble and they are not responding.
"It is a disaster, we have no light, no telephones, the rescue services have not got here yet."
"Half the village has disappeared," said Sergio Pirozzi, mayor of Amatrice, a mountain village in neighbouring Lazio that was packed with visitors at the peak of the summer season.
"There is a landslide on one road, a bridge is about to collapse on the other one," he said, according to the AGI news agency.
Amatrice is famous in Italy as a beauty spot and is a popular holiday destination for Romans seeking cool mountain air at the height of the summer.
The first quake struck shortly after 3.30 AM, according to the United States Geological Survey, and a 5.4 magnitude aftershock followed an hour later.
USGS's PAGER system, which predicts the impact of earthquakes, issued a red alert -- suggesting significant casualties and damage based on previous quake data.
In 2009 a 6.3-magnitude earthquake in the Aquila region, which was also felt in the Italian capital, left more than 300 dead.
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