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Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria
Abstract
Objectives To describe and validate the Athens Insomnia Scale (AIS).Methods The AIS is a self-assessment psychometric instrument designed for quantifying sleep difficulty based on the ICD-10 criteria. It consists of eight items: the first five pertain to sleep induction, awakenings during the night, final awakening, total sleep duration, and sleep quality; while the last three refer to well-being, functioning capacity, and sleepiness during the day. Either the entire eight-item scale (AIS-8) or the brief five-item version (AIS-5), which contains only the first five items, can be utilized. The validation of the AIS was based on its administration to 299 subjects: 105 primary insomniacs, 144 psychiatric patients and 50 non-patient controls.Results Regarding internal consistency, for both versions of the scale, the Cronbach's alpha was around 0. 90 and the mean item-total correlation coefficient was about 0.70. Moreover, in the factor analysis, the scale emerged as a sole component. The test-retest reliability correlation coefficient was found almost 0.90 at a 1-week interval. As far as external validity is concerned, the correlations of the AIS-8 and AIS-5 with the Sleep Problems Scale were 0.90 and 0.85, respectively.Conclusion The high measures of consistency, reliability, and validity of the AIS make it an invaluable tool in sleep research and clinical practice.
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“For example, questionnaire measures of insomnia commonly include both nocturnal and daytime symptoms [54,55,61].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [55]
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Woznica, A. A., Carney, C. E., Kuo, J. R., & Moss, T. G. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.10.004 · Cited by 124
Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal
Lowe, H., Haddock, G., Mulligan, L. D., Gregg, L., Fuzellier-Hart, A., Carter, L.-A., & Kyle, S. D. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.11.002 · Cited by 121
Kita, T., Yoshioka, E., Satoh, H., Saijo, Y., Kawaharada, M., Okada, E., & Kishi, R. (2011) · Diabetes Care · doi:10.2337/dc11-1455 · Cited by 122
“However, using the AIS as a measurement of sleep quality already has been validated as an invaluable tool in sleep research and clinical practice (18).”
MethodZhan, Y., Liu, Y., Liu, H., Li, M., Shen, Y., Gui, L., Zhang, J., Luo, Z., Tao, X., & Yu, J. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13094 · Cited by 132
“The AIS was developed by the Department of Sleep Psychiatry, University of Athens Medical School, Greece, in 2000 (Soldatos et al., 2000).”
MethodMysliwiec, V., Martin, J. L., Ulmer, C. S., Chowdhuri, S., Brock, M. S., Spevak, C., & Sall, J. (2020) · Annals of Internal Medicine · doi:10.7326/m19-3575 · Cited by 129
“Reviewed, newly added 30.”
Sleep disturbances in depression and the effects of antidepressants
Argyropoulos, S., & Wilson, S. J. (2005) · International Review of Psychiatry · doi:10.1080/09540260500104458 · Cited by 123
Relationships of Occupational Stress to Insomnia and Short Sleep in Japanese Workers
Utsugi, M. T., Saijo, Y., Yoshioka, E., Horikawa, N., Sato, T., Gong, Y., & Kishi, R. (2005) · SLEEP · doi:10.1093/sleep/28.6.728 · Cited by 114
Sleep Quality and Mental Health of Medical Students in Greece During the COVID-19 Pandemic
Eleftheriou, A., Rokou, A., Arvaniti, A., Nena, E., & Steiropoulos, P. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.775374 · Cited by 122
“Higher scores suggest severe symptoms of insomnia (17).”
BackgroundMethodInfluentialShift Work Disorder in a Random Population Sample – Prevalence and Comorbidities
Milia, L. V. D., Waage, S., Pallesen, S., & Bjorvatn, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055306 · Cited by 116
“Insomnia was classified using the Athens Insomnia Scale [16].”
MethodCortoos, A., Valck, E. D., Arns, M., BRETELER, M. H. M., & Cluydts, R. (2009) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-009-9116-z · Cited by 111
“…were used: Pittsburgh Sleep Quality Index (PSQI; Buysse et al. 1989), Epworth Sleepiness Scale (ESS; Johns 1991) Athens Insomnia Scale (AIS; Soldatos et al. 2000), State Trait Anxiety Index (STAI; Spielberger 1983), Beck Depression Inventory (BDI; Beck et al. 1988), Presleep Arousal Scale…”
COVID-19: PTSD symptoms in Greek health care professionals.
Blekas, A., Voitsidis, P., Athanasiadou, M., Parlapani, E., Chatzigeorgiou, A. F., Skoupra, M., Syngelakis, M., Holeva, V., & Diakogiannis, I. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000914 · Cited by 113
Sleep Problems in Patients with Rheumatoid Arthritis
Westhovens, R., der Elst, K. V., Matthys, A., Tran, M., & Gilloteau, I. (2013) · The Journal of Rheumatology · doi:10.3899/jrheum.130430 · Cited by 110
Cohen, S. P., Peterlin, B. L., Fulton, L., Neely, E. T., Kurihara, C., Gupta, A., Mali, J., Fu, D. C., Jacobs, M. B., Plunkett, A., et al. (2015) · Pain · doi:10.1097/j.pain.0000000000000373 · Cited by 110
Zavecz, Z., Nagy, T., Galkó, A., Németh, D., & Janacsek, K. (2020) · Scientific Reports · doi:10.1038/s41598-020-61627-6 · Cited by 122
Boredom proneness and sleep disorders as predictors of adult attention deficit scores
Kass, S. J., Wallace, J. C., & Vodanovich, S. J. (2003) · Journal of Attention Disorders · doi:10.1177/108705470300700202 · Cited by 116
“While the AIS is a relatively new assessment tool, it has shown initial promise in assessing the construct of insomnia as demonstrated by the high correlation between the AIS and the Sleep Problems Scale (correlation coefficient ranging from .85 to .90; Soldatos et al., 2000).”
MethodYen, C., Yang, P., Wang, P., Lin, H., Liu, T., Wu, Y., & Tang, T. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.06.001 · Cited by 107
“Athens Insomnia Scale (AIS-8) We used the Taiwanese version of the 8-item AIS-8 to assess the severity of subjective insomnia over the last month [26,27].”
MethodSleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings
Mercadante, S., Aielli, F., Adile, C., Ferrera, P., Valle, A., Cartoni, C., Pizzuto, M., Caruselli, A., Parsi, R., Cortegiani, A., et al. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2015.06.018 · Cited by 106
Kovacs, A. Z., Molnar, M. Z., Szeifert, L., Ambrus, C., Molnar-Varga, M., Szentkirályi, A., Mucsi, I., & Novák, M. (2010) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfq476 · Cited by 106
Simor, P., Zavecz, Z., Pálosi, V., Török, C., & Köteles, F. G. (2014) · Chronobiology International · doi:10.3109/07420528.2014.935786 · Cited by 106
“Athens Insomnia Scale (AIS) The AIS is a reliable and valid instrument that can be used in epidemiological studies for the measurement of insomnia (Soldatos et al., 2000).”
MethodInsomnia and stress of physicians during COVID-19 outbreak
Abdulah, D. M., & Musa, D. H. (2020) · Sleep Medicine X · doi:10.1016/j.sleepx.2020.100017 · Cited by 105
“A cut-off score of 6 has been determined to distinguish between insomnia and healthy subjects [11].”
Ten questions concerning thermal environment and sleep quality
Lan, L., & Lian, Z. (2016) · Building and Environment · doi:10.1016/j.buildenv.2016.01.017 · Cited by 106
Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia
Chemerinski, E., Ho, B.-C., Flaum, M., Arndt, S., Fleming, F., & Andreasen, N. C. (2002) · Comprehensive Psychiatry · doi:10.1053/comp.2002.34627 · Cited by 101
Depression and its associated factors among elderly: A community-based study in Egypt
El‐Gilany, A., Elkhawaga, G. O., & Sarraf, B. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.04.011 · Cited by 102
The Meaning of Sleep Quality: A Survey of Available Technologies
Crivello, A., Barsocchi, P., Girolami, M., & Palumbo, F. (2019) · IEEE Access · doi:10.1109/access.2019.2953835 · Cited by 124
Suicide risk during the lockdown due to coronavirus disease (COVID-19) in Colombia
Caballero‐Domínguez, C. C., Jiménez‐Villamizar, M. P., & Campo‐Arias, A. (2020) · Death Studies · doi:10.1080/07481187.2020.1784312 · Cited by 105
“Insomnia risk Insomnia risk was quantified with the Athens Insomnia Scale (Soldatos et al., 2000).”
BackgroundMethodInfluentialInsomnia as a predictor of high-lethality suicide attempts
Pompili, M., Innamorati, M., Forte, A., Longo, L., Mazzetta, C., Erbuto, D., Ricci, F., Palermo, M., Stefani, H., Seretti, M. E., et al. (2013) · International Journal of Clinical Practice · doi:10.1111/ijcp.12211 · Cited by 100
Psychometric properties of Youth Self-Rating Insomnia Scale (YSIS) in Chinese adolescents
Liu, X., Yang, Y., Liu, Z., Luo, Y., Fan, F., & Jia, C.-X. (2019) · Sleep and Biological Rhythms · doi:10.1007/s41105-019-00222-3 · Cited by 103
Okajima, I., Miyamoto, T., Ubara, A., Omichi, C., Matsuda, A., Sumi, Y., Matsuo, M., Ito, K., & Kadotani, H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17238789 · Cited by 111
Møst, E. I. S., Aboudan, S., Scheltens, P., & Someren, E. J. W. V. (2012) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318252e3ff · Cited by 100
Terauchi, M., Horiguchi, N., 梶山, 明., Akiyoshi, M., Owa, Y., Kato, K., & Kubota, T. (2014) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000200 · Cited by 99
“The AIS was developed as a brief and easy-to-administer self-assessment questionnaire for estimating severity of insomnia defined according to the International Classification of Diseases Tenth Revision, and its internal consistency and test-retest reliability have been confirmed.(26) The scale consists of eight items…”
MethodCircadian Phase and Phase Angle Disorders in Primary Insomnia
Flynn‐Evans, E. E., Shekleton, J. A., Miller, B., Epstein, L. J., Kirsch, D. B., Brogna, L. A., Burke, L. M., Bremer, E., Murray, J. M., Gehrman, P., et al. (2017) · SLEEP · doi:10.1093/sleep/zsx163 · Cited by 99
Predictors of primary medical care consultation for sleep disorders.
Bartlett, D., Marshall, N., Williams, A., & Grunstein, R. (2008) · Sleep Medicine · doi:10.1016/j.sleep.2007.09.002 · Cited by 102
“Sleep quality and quantity were measured by comparing people reporting ‘‘sufficient sleep’’ or ‘‘slightly insufficient sleep,’’ with all others (‘‘markedly insufficient,’’ ‘‘very insufficient’’ and ‘‘did not sleep at all’’ tick boxes) [17,18].”
MethodDiagnostic and treatment algorithm for chronic nodular prurigo
Ständer, H. F., Elmariah, S. B., Zeidler, C., Spellman, M. C., & Ständer, S. (2019) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2019.07.022 · Cited by 96
Sella, E., Miola, L., Toffalini, E., & Borella, E. (2021) · Health Psychology Review · doi:10.1080/17437199.2021.1974309 · Cited by 107
“…Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989); JSC: Jenkins Sleep Scale (Jenkins et al., 1988); ISI: Insomnia Severity Index (ISI; Bastien et al., 2001); AIS: Athens Insomnia Scale-5 (Soldatos et al., 2000); SDQ: Sleep Disturbance Questionnaire (Douglass et al., 1994); SF-36:…”
BackgroundMethodInsomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis
Tan, L.-H., Chen, P., Chiang, H., King, E., Yeh, H., Hsiao, Y., Chang, D. R., Chen, S.-H., Wu, M.-Y., & Kuo, C. (2022) · Kidney Medicine · doi:10.1016/j.xkme.2022.100458 · Cited by 94
“Furthermore, owing to the significant variation in studies’ insomnia definitions, studies were included only if the following conditions were met: (1) patients were determined to have insomnia by presenting at least 1 of 4 insomnia complaints listed in the primary criteria and at least 1 of 4 insomnia complaints liste…”
MethodInsomnia and its correlates in a representative sample of the Greek population
Paparrigopoulos, T. J., Tzavara, C. K., Theleritis, C. G., Psarros, C., Soldatos, C. R., & Tountas, Y. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-531 · Cited by 93
“total sleep duration, and sleep quality; while the last three refer to well-being, functioning capacity, and sleepiness during the day [ 34 ].”
Background
Metadata
- Authors
- Soldatos, C. R., Dikeos, D. G., & Paparrigopoulos, T. J.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Soldatos, Constantin R
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2000-06
- Volume
- 48
- Issue
- 6
- Pages
- 555-560
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2021553431
- Cited by
- 1,754
- References
- 34
- Citations by year
- 2026: 196 · 2025: 187 · 2024: 194 · 2023: 184 · 2022: 155 · 2021: 174 · 2020: 110 · 2019: 89 · 2018: 69 · 2017: 54 · 2016: 54 · 2015: 35 · 2014: 41 · 2013: 30 · 2012: 39
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Athens Insomnia Scale, insomnia, sleep disorders, ICD-10 diagnostic criteria, self-report questionnaire, psychometric validation, sleep induction, nocturnal awakenings, sleep quality, daytime sleepiness, psychiatric patients, short-form scale
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Personality Inventory, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results, Comorbidity
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