Cited by 1,754Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and Testing

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Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria

Soldatos, Constantin R, Dikeos, Dimitris G, Paparrigopoulos, Thomas J·2000·Journal of Psychosomatic Research

DOI 10.1016/s0022-3999(00)00095-7

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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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BackgroundMethodInfluential
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Pedrozo‐Pupo, J. C., & Campo‐Arias, A. (2020) · Chronic Respiratory Disease · doi:10.1177/1479973120962800 · Cited by 62
A Comprehensive Evaluation of Standardized Assessment Tools in the Diagnosis of Fibromyalgia and in the Assessment of Fibromyalgia Severity
Boomershine, C. S. (2011) · Pain Research and Treatment · doi:10.1155/2012/653714 · Cited by 68
“The AIS cannot only quantify the severity of sleep problems but also be used to diagnose patients with insomnia [67].”
Method
Anxiety and its association with perceived stress and insomnia among nurses fighting against COVID‐19 in Wuhan: A cross‐sectional survey
Shen, Y., Zhan, Y., Zheng, H., Liu, H., Wan, Y., & Zhou, W. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.15678 · Cited by 68
Restless legs syndrome, insomnia, and quality of life after renal transplantation
Molnar, M. Z., Novák, M., Szeifert, L., Ambrus, C., Keszei, A. P., Kóczy, Á., Lindner, A. V., Barótfi, S., Szentkirályi, A., Remport, Á., et al. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.06.007 · Cited by 61
“The AIS was used to assess sleep complaints and identify insomnia [15,17].”
Method
Relationship Between Loneliness and Frailty Among Older Adults in Nursing Homes: The Mediating Role of Activity Engagement
Zhao, M., Gao, J., Li, M., & Wang, K. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.11.007 · Cited by 61
A very brief self-report scale for measuring insomnia severity using two items from the Insomnia Severity Index - development and validation in a clinical population
Kraepelien, M., Blom, K., Forsell, E., Isacsson, N. H., Bjurner, P., Morin, C. M., Jernelöv, S., & Kaldo, V. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.03.003 · Cited by 60
Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit
Mercadante, S., Adile, C., Ferrera, P., Masedu, F., Valenti, M., & Aielli, F. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3524-4 · Cited by 60
“The high measures of consistency, reliability, and validity of the AIS make it an invaluable tool in sleep research and clinical practice [10, 11].”
Background
Reliability and validity of the Athens Insomnia Scale in chronic pain patients
Enomoto, K., Adachi, T., Yamada, K., Inoue, D., Nakanishi, M., Nishigami, T., & Shibata, M. (2018) · Journal of Pain Research · doi:10.2147/jpr.s154852 · Cited by 61
“10,14,15,17 The factor structure of the AIS-5 is reported as a 1-factor structure only.”
Influential
Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia
Amutio, A., Franco, C., Sánchez-Sánchez, L. C., Pérez-Fuentes, M. D. C., Gázquez-Linares, J. J., Van Gordon, W., & Molero-Jurado, M. D. M. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01365 · Cited by 60
Perception of Health Conditions and Test Availability as Predictors of Adults’ Mental Health during the COVID-19 Pandemic: A Survey Study of Adults in Malaysia
Dai, H., Zhang, S. X., Looi, K. H., Su, R., & Li, J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17155498 · Cited by 59
“According to Table 1, the mean scores of insomnia (AIS-5), anxiety (GAD-7), depression (PHQ-9), and distress (K6) were 1.76 (standard deviation (SD) = 0.84), 4.36 (SD = 4.89), 4.49 (SD = 5.03), and 5.10 (SD = 5.73), respectively.”
BackgroundMethodInfluential
Nighttime cardiac sympathetic hyper-activation in young primary insomniacs
de Zambotti, M., Covassin, N., Sarlo, M., Tona, G. D. M., Trinder, J. C., & Stegagno, L. (2012) · Clinical Autonomic Research · doi:10.1007/s10286-012-0178-2 · Cited by 58
Factors Associated With Healthcare Workers' Insomnia Symptoms and Fatigue in the Fight Against COVID-19, and the Role of Organizational Support
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Sleep disorders in psychiatric practice.
Szelenberger, W., & Soldatos, C. R. (1986) · PubMed Central · Cited by 58
Sleep patterns and the risk for ADHD: a review
Gruber, R. (2012) · Nature and Science of Sleep · doi:10.2147/nss.s31269 · Cited by 66
Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine
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Prevalence and clinical characteristics of insomnia and its subtypes in the Korean elderly
Kim, K. W., Kang, S.-H., Yoon, I., Lee, S. D., Ju, G., Han, J. W., Kim, T. H., Lee, C. S., & Kim, T. (2016) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2016.09.005 · Cited by 57
Inflammatory markers and their possible effects on cognitive function in women with posttraumatic stress disorder
Imai, R., Hori, H., Itoh, M., Lin, M., Niwa, M., Ino, K., Ogawa, S., Ishida, M., Sekiguchi, A., Matsui, M., et al. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.04.009 · Cited by 63
Rotating night shift work and non-alcoholic fatty liver disease among steelworkers in China: a cross-sectional survey
Zhang, S., Wang, Y., Wang, Z., Wang, H., Xue, C., Li, Q., Guan, W., & Yuan, J. (2020) · Occupational and Environmental Medicine · doi:10.1136/oemed-2019-106220 · Cited by 57
Job Stress Factors, Stress Response, and Social Support in Association with Insomnia of Japanese Male Workers
Nishitani, N., & Sakakibara, H. (2010) · Industrial Health · doi:10.2486/indhealth.48.178 · Cited by 56
Prevention of depression and sleep disturbances in elderly with memory-problems by activation of the biological clock with light - a randomized clinical trial
Møst, E. I. S., Scheltens, P., & Someren, E. J. W. V. (2010) · Trials · doi:10.1186/1745-6215-11-19 · Cited by 58
“The Athens Insomnia Scale (AIS) is a questionnaire consisting of eight items, based on the criteria of the 10th edition of the International Classification of Diseases, (ICD-10) [ 86 ].”
Method
The efficacy and mechanisms of a guided self-help intervention based on mindfulness in patients with breast cancer: a randomized controlled trial.
Shao, D., Zhang, H., Cui, N., Sun, J., Li, J., & Cao, F. (2021) · Cancer · doi:10.1002/cncr.33381 · Cited by 57
“The Athens Insomnia Scale was used to assess sleep problems.(34) The scale comprises 8 items, and each item is scored from 0 (never) to 3 (severe).”
Method
Validation of the Japanese version of the Ford Insomnia Response to Stress Test and the association of sleep reactivity with trait anxiety and insomnia
Nakajima, S., Okajima, I., Sasai, T., Kobayashi, M., Furudate, N., Drake, C. L., Roth, T. G., & Inoue, Y. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.09.022 · Cited by 58
“The research questionnaires consisted of the FIRST-J, items related to demographic information, questionnaires assessing subjective severity of insomnia (the Pittsburgh Sleep Quality Index [PSQI] [30,31], the Athens Insomnia Scale [AIS] [32,33]) and a questionnaire to assess trait anxiety (State-Trait Anxiety Inventor…”
Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults
Okuyama, M., Takaishi, O., Nakahara, K., Iwakura, N., Hasegawa, T., Oyama, M., Inoue, A., Ishizu, H., Satoh, H., & Fujiwara, Y. (2016) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2016.1224383 · Cited by 55
“The original AIS is a self-rating inventory consisting of eight items.[12,13] The first five assess difficulty in falling asleep, awakening during the night, early morning awakening, total sleep duration, and overall quality of sleep, which are representative of AIS nocturnal.”
Background
Insomnia and PTSD one month after wildfires: evidence for an independent role of the “fear of imminent death”
Psarros, C., Theleritis, C. G., Economou, M. P., Tzavara, C. K., Kioulos, K. T., Mantonakis, L., Soldatos, C. R., & Bergiannaki, J.-D. (2017) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2016.1276192 · Cited by 54
“…on the criteria of the latest classification systems (ICD-10, DSM-IV-TR, ICSD), in which the clinical approach prevails and the diagnosis of insomnia is based on the patient's subjective perception of unsatisfactory sleep quantity and/or quality (Soldatos et al. 2000, 2003; Dikeos et al. 2008).”
BackgroundMethod
Bidirectional relationship between insomnia and frailty in older adults: A 2-year longitudinal study
Nemoto, Y., Sato, S., Kitabatake, Y., Nakamura, M., Takeda, N., Maruo, K., & Arao, T. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104519 · Cited by 54
Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up
Zhou, Z., Luo, H., Liu, J., Du, Y., Zhao, W., Zhou, X.-L., Zeng, M., Yang, D., Xie, X., Huang, S., et al. (2021) · Neural Regeneration Research · doi:10.4103/1673-5374.327361 · Cited by 54
“All participants underwent fMRI scanning and completed several questionnaires that included information on age, sex, education level, smoking history, handedness, the Athens Insomnia Scale (AIS) (Soldatos et al., 2000), and the Hospital Anxiety and Depression Scale (HADS) (Michopoulos et al.”
BackgroundInfluential
The association between loneliness and sleep quality among older adults: A systematic review and meta-analysis
Deng, M., Qian, M., Lv, J., Guo, C., & Yu, M. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.11.013 · Cited by 61
Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): Reliability, initial validity and normative scores in higher education students
Gomes, A. A., Marques, D. R., Meia-Via, A. M. S., Meia-Via, M. S., Tavares, J., da Silva, C. F., & de Azevedo, M. H. P. (2014) · Chronobiology International · doi:10.3109/07420528.2014.986681 · Cited by 79
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Is dietary melatonin supplementation a viable adjunctive therapy for chronic periodontitis?—A randomized controlled clinical trial
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Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox
Hirano, T., Motohashi, T., Okumura, K., Takajo, K., Kuroki, T., Ichikawa, D., Matsuoka, Y., Ochi, E., & Ueno, T. (2020) · Journal of Medical Internet Research · doi:10.2196/18938 · Cited by 61
“Sleep is assessed by the Athens Insomnia Scale [38].”
Method
Post-traumatic Growth and Related Influencing Factors in Discharged COVID-19 Patients: A Cross-Sectional Study
Yan, S., Yang, J., Ye, M., Chen, S., Xie, C.-Y., Huang, J., & Liu, H. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.658307 · Cited by 64
“The limitations of the electronic questionnaire meant that we did not ask participants about general conditions with the full classical scales, such as the Athens Insomnia Scale for assessment of the sleep quality (Soldatos et al., 2000) and the Barthel index of ADL for assessment of the self-care ability (Collin et a…”
Method
Reliability and validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN): comparing psychiatric patients with control subjects
Takács, J., Bódizs, R., Ujma, P. P., Horváth, K., Rajna, P., & Harmat, L. (2016) · Sleep And Breathing · doi:10.1007/s11325-016-1347-7 · Cited by 55
“We also measured the discriminant validity of the components of the PSQI-HUN as well as its convergent validity with regard to the Hungarian version of Beck Depression Inventory (BDI) [9], Athens Insomnia Scale (AIS) [10, 11], and Spielberger Trait Anxiety Scale (STAIT) [12] subscores.”
Method
Sleep disorders and quality of life in renal transplant recipients
Molnar, M. Z., Novák, M., & Mucsi, I. (2009) · International Urology and Nephrology · doi:10.1007/s11255-009-9527-z · Cited by 53
“[61, 62] have been developed and validated.”
Quality of sleep in renal transplant recipients and patients on hemodialysis
Liaveri, P., Dikeos, D. G., Ilias, Ι., Lygkoni, E., Boletis, I. N., Skalioti, C., & Paparrigopoulos, T. J. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.12.013 · Cited by 57
Reduction of nocturnal slow-wave activity affects daytime vigilance lapses and memory encoding but not reaction time or implicit learning
Van Der Werf, Y. D., Altena, E., Vis, J. C., Koene, T., & Van Someren, E. J. W. (2011) · Progress in Brain Research · doi:10.1016/b978-0-444-53839-0.00016-8 · Cited by 51
“, 2010), we performed an extensive screening: in brief, sleep disorders were excluded on the basis of the Athens Insomnia Scale (AIS; Soldatos et al., 2000), the Pittsburgh Sleep Quality Index (PSQI; Buysse et al.”
Method
Associations Between Online Learning, Smartphone Addiction Problems, and Psychological Symptoms in Chinese College Students After the COVID-19 Pandemic
Zhang, C., Hao, J., Liu, Y., Cui, J., & Yu, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.881074 · Cited by 57
Discrepancies between subjective and objective sleep assessments revealed by in-home electroencephalography during real-world sleep
Masaki, M., Tsumoto, S., Tani, A., Tominaga, M., Seol, J., Chiba, S., Miyanishi, K., Nishida, K., Kawana, F., Amemiya, T., et al. (2025) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2412895121 · Cited by 57
“The same trend was observed for the agreement between subjective and objective insomnia: Among those with an AIS score of 6 or higher, i.e., those with subjective insomnia in the traditional criteria, the proportion judged to have objective insomnia was 33.8% over multiple nights, compared to only 21.3% for just one n…”
Influential
Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial.
Sun, J.-L., Sung, M., Huang, M.-R., Cheng, G., & Lin, C.-C. (2010) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2009.12.003 · Cited by 61
Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients
Pataka, A., Kotoulas, S., Kalamaras, G., Schiza, S., Sapalidis, K. G., Giannakidis, D., Michalopoulos, N., Koulouris, C., Aidoni, Z., Amaniti, A., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9010130 · Cited by 51
“A general sleep questionnaire of the sleep laboratory (sleep habits, snoring, witnessed apneas, leg movements, and nocturia), Epworth Sleepiness Scale (ESS) [8], STOP and STOP Bang (SB) [9], Berlin Questionnaire (BQ) [10], Athens Insomnia Scale (AIS) [11] and Fatigue Scale (FS) [12] was completed by the participants.”
BackgroundMethod

Authors: Soldatos, C. R., Dikeos, D. G., & Paparrigopoulos, T. J.
Affiliations: National and Kapodistrian University of Athens (GR)
Corresponding author: Soldatos, Constantin R
ORCID: Soldatos, Constantin R
Dikeos, Dimitris G
Paparrigopoulos, Thomas J
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 2000-06
Volume: 48
Issue: 6
Pages: 555-560
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/s0022-3999(00)00095-7
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria

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