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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Huang, L. J., Tang, X.-G., Zhang, J.-H., Li, Q., Yu, J., Ding, X., Qin, J., & Gao, X. (2014) · Clinical Interventions in Aging · doi:10.2147/cia.s67052 · Cited by 27
Incorporating measures of sleep quality into cancer studies
Redeker, N. S., Pigeon, W. R., & Boudreau, E. A. (2014) · Supportive Care in Cancer · doi:10.1007/s00520-014-2537-0 · Cited by 27
An integrative review of acupressure interventions for older people: A focus on sleep quality, depression, anxiety, and agitation
Hmwe, N. T. T., Browne, G., Mollart, L. J., Allanson, V., & Chan, S. W. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5031 · Cited by 26
“The Translated Athens Insomnia Scale is a valid tool used to assess severity of insomnia in different populations, including older adults.(37,51,52) The Epworth Sleepiness Scale is used to assess subjective daytime sleepiness that is frequently used in research to evaluate the severity of excessive daytime sleepiness…”
Method
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Hellström, A., Hagell, P., Broström, A., Ulander, M., Luik, A. I., Espie, C. A., & Årestedt, K. (2019) · PLOS ONE · doi:10.1371/journal.pone.0213533 · Cited by 25
Prevalence and Characterization of Psychological Trauma in Patients with Fibromyalgia: A Cross-Sectional Study
Gardoki-Souto, I., Redolar-Ripoll, D., Fontana, M., Hogg, B., Castro, M. J., Blanch, J. M., Ojeda, F., Solanes, A., Radua, J., Valiente-Gómez, A., et al. (2022) · Pain Research and Management · doi:10.1155/2022/2114451 · Cited by 36
“Participants showed marked scores in the AIS (MD� 14.14; SD� 0.52) suggestive of sleep disturbances and an important degree of dissatisfaction with their lives according to the SWLS scores (MD� 11.78; SD� 0.49).”
MethodInfluential
Anemia and insomnia: a cross-sectional study and meta-analysis
Neumann, S., Li, J.-J., Yuan, X.-D., Chen, S.-H., Ma, C.-R., Murray‐Kolb, L. E., Shen, Y., Wu, S., & Gao, X. (2020) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001306 · Cited by 26
“A total AIS score ≥6was considered insomnia.([19]) The AIS questionnaire has been validated in China with 83% test-retest readability, 96% sensitivity, and 76% specificity.”
Method
The impact of insomnia on anxiety and depression: a longitudinal study of non-clinical young Chinese adult males
Mao, X., Zhang, F., Wei, C., Li, Z., Huang, C., Sun, Z., Zhang, J., Deng, W., Hou, T., & Dong, W. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04873-y · Cited by 26
“has previously shown high consistency, reliability, and external validity [23, 24].”
Background
The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial
Min, B., Park, H., Kim, J. I., Lee, S., Back, S., Lee, E.-H., Oh, S., Yun, J., Kim, B.-N., Kim, Y., et al. (2023) · JMIR mhealth and uhealth · doi:10.2196/42851 · Cited by 31
“Insomnia was assessed by the AIS, which consisted of 8 items with a 4-point Likert scale, with higher scores reflecting greater severity of insomnia [43].”
Method
Randomised Controlled Trial (RCT) of cannabinoid replacement therapy (Nabiximols) for the management of treatment-resistant cannabis dependent patients: a study protocol
Agonist Replacement for Cannabis Dependence (ARCD) study group, Bhardwaj, A. K., Allsop, D. J., Copeland, J., McGregor, I. S., Dunlop, A. J., Shanahan, M., Bruno, R., Phung, N., Montebello, M. E., et al. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1682-2 · Cited by 25
“Subjective sleep ratings are assessed using the Insomnia Sleep Inventory [54].”
Impact of Sleep Disorders and Other Factors on the Quality of Life in General Population
Hallit, S. R., Hajj, A., Sacre, H., Karaki, G. A., Malaeb, D. N., Kheir, N., Salameh, P., & Hallit, R. R. (2019) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000968 · Cited by 27
Sleep disorders among educationally active elderly people in Bialystok, Poland: a cross-sectional study
Cybulski, M., Cybulski, Ł., Krajewska-Kułak, E., Orzechowska, M., Cwalina, U., & Kowalczuk, K. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1248-2 · Cited by 27
The global mental health burden of COVID-19 on critical care staff
Ezzat, A., Li, Y., Holt, J., & Komorowski, M. (2021) · British Journal of Nursing · doi:10.12968/bjon.2021.30.11.634 · Cited by 25
Performance validity in outpatients with multiple sclerosis and cognitive complaints
Nauta, I. M., Bertens, D., van Dam, M., Huiskamp, M., Driessen, S., Geurts, J. J. G., Uitdehaag, B. M. J., Fasotti, L., Hulst, H. E., de Jong, B., et al. (2021) · Multiple Sclerosis Journal · doi:10.1177/13524585211025780 · Cited by 25
Effect of smartphone-based cognitive behavioral therapy app on insomnia: a randomized, double-blind study
Watanabe, Y., Kuroki, T., Ichikawa, D., Ozone, M., Uchimura, N., & Ueno, T. (2022) · SLEEP · doi:10.1093/sleep/zsac270 · Cited by 25
Association between Pruritus and Psychosocial Well-being: A Population-based Study among 6,809 Subjects
Sinikumpu, S., Jokelainen, J. J., Tasanen, K., Timonen, M., & Huilaja, L. (2023) · Acta Dermato Venereologica · doi:10.2340/actadv.v103.2922 · Cited by 25
“The question regarding sleep disturbance was addressed with the modified Athens Insomnia Scale (AIS) including the following items: 1: Sleep induction; 2: Awakenings during the night; 3: Final awakening; 4: Total sleep duration; and 5: Sleep quality (16).”
BackgroundMethod
Examining bedtime procrastination, study engagement, and studyholism in undergraduate students, and their association with insomnia
Alshammari, T. K., Rogowska, A. M., Basharahil, R. F., Alomar, S. F., Alseraye, S., Aljuffali, L. A., Al-Rasheed, N. M., & Alshammari, M. A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1111038 · Cited by 30
Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial
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“The AIS 18 was used to assess sleep problems during the ﬁrst night after surgery, which consists of eight items: sleep induction, awakenings during the night, early morning awakening, total sleep time and overall quality of sleep, problems with the sense of well-being, overall functioning, and sleepiness during the da…”
BackgroundMethodInfluential
The association between insomnia and suicidal thoughts in adults treated for alcohol dependence in Poland
Klimkiewicz, A., Bohnert, A. M., Jakubczyk, A., Ilgen, M. A., Wojnar, M., & Brower, K. J. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.09.021 · Cited by 25
Increased Frequency of Restless Legs Syndrome in Myasthenia Gravis
Siemiński, M., Bilińska, M. M., & Nyka, W. M. (2012) · European Neurology · doi:10.1159/000339485 · Cited by 25
Sleep physiology and pathology: Pertinence to psychiatry
Soldatos, C. R., & Paparrigopoulos, T. J. (2005) · International Review of Psychiatry · doi:10.1080/09540260500104565 · Cited by 25
Self-efficacy and well-being in the association between caregiver burden and sleep quality among caregivers of elderly patients having multiple chronic conditions in rural China: a serial multiple mediation analysis
Yang, Z., Sun, F., Zhao, L., Hu, T., Lin, X., & Guo, Y. (2023) · BMC Nursing · doi:10.1186/s12912-023-01587-0 · Cited by 26
“The AIS was employed to examine caregivers’ sleep quality [38, 39].”
Method
Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials
Silva, S., Hayden, J. A., Mendes, G., Verhagen, A. P., Pinto, R. Z., & Silva, A. (2024) · SLEEP · doi:10.1093/sleep/zsae023 · Cited by 28
Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model
Pachi, A., Sikaras, C., Melas, D. S., Alikanioti, S., Soultanis, N., Ivanidou, M., Ilias, Ι., & Tselebis, A. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14041145 · Cited by 26
“The Greek version of the AIS has demonstrated good psychometric properties [79].”
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Hagiwara, Y., Yabe, Y., Yamada, H., Watanabe, T., Kanazawa, K., Koide, M., Sekiguchi, T., Hatano, H., & Itoi, E. (2017) · Journal of Occupational Health · doi:10.1539/joh.16-0203-oa · Cited by 24
Relationships of blood proinflammatory markers with psychological resilience and quality of life in civilian women with posttraumatic stress disorder
Imai, R., Hori, H., Itoh, M., Lin, M., Niwa, M., Ino, K., Ogawa, S., Sekiguchi, A., Kunugi, H., Akechi, T., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-54508-0 · Cited by 26
Association between the social isolation and depressive symptoms after the great East Japan earthquake: findings from the baseline survey of the TMM CommCohort study
Kotozaki, Y., Tanno, K., Sakata, K., Takusari, E., Otsuka, K., Tomita, H., Sasaki, R., Takanashi, N., Mikami, T., Hozawa, A., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-10896-5 · Cited by 25
“Insomnia was determined by a score of ≥6 on the Athens Insomnia Scale [38, 39].”
MethodInfluential
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Personality Type D, Level of Perceived Stress, Insomnia, and Depression Among High School Teachers in Poland
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Determinants of Sleep Disorders and Occupational Burnout among Nurses: A Cross-Sectional Study
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“92) of the AIS were found to be very satisfactory [26].”
Background
An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research
Jakobsen, G., Gjeilo, K. H., Hjermstad, M. J., & Klepstad, P. (2022) · Cancers · doi:10.3390/cancers14163933 · Cited by 24
“The time interval in the ISI is the last two weeks [27], and the AIS is during the last month, or some other period of time, whose length depends on the purpose of a given study [28].”
BackgroundMethod
Cannabis Use and Sleep Quality in Daily Life: a Daily Diary Study of Adults Starting Cannabis for Health Concerns
Tervo‐Clemmens, B., Schmitt, W. A., Wheeler, G. L., Cooke, M. E., Schuster, R. M., Hickey, S., Pachas, G. N., Evins, A. E., & Gilman, J. M. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109760 · Cited by 24
The Impact of Fatigue on Sleep and Other Non-Motor Symptoms in Parkinson’s Disease
Diaconu, Ș., Monescu, V., Filip, R., Marian, L. E., Kakucs, C., Murășan, I., Chaudhuri, К. R., Jianu, D. C., Falup‐Pecurariu, C., & Opriţoiu, B. (2024) · Brain Sciences · doi:10.3390/brainsci14040397 · Cited by 24
“…Sleep scale-2 (PDSS-2) [39], Scales for Outcomes in Parkinson’s Disease (SCOPA)– Sleep [40], Pittsburgh Sleep Quality Index (PSQI) [41], Insomnia Severity Index (ISI) [42], Athens Insomnia Scale (AIS) [43], Epworth Sleepiness Scale (ESS) [44], and International Restless Legs Scale (IRLS) [45].”
Method
Housing type after the Great East Japan Earthquake and loss of motor function in elderly victims: a prospective observational study
Ito, K., Tomata, Y., Kogure, M., Sugawara, Y., Watanabe, T., Asaka, T., & Tsuji, I. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012760 · Cited by 24
Weight Gain in Survivors Living in Temporary Housing in the Tsunami-Stricken Area during the Recovery Phase following the Great East Japan Earthquake and Tsunami
Takahashi, S., Yonekura, Y., Sasaki, R., Yokoyama, Y., Tanno, K., Sakata, K., Ogawa, A., Kobayashi, S., & Yamamoto, T. (2016) · PLoS ONE · doi:10.1371/journal.pone.0166817 · Cited by 24
Prevalence of insomnia and its associated factors among rural elderly: a community based study
El‐Gilany, A., Saleh, N. M. H., Mohamed, H., & Elsayed, E. (2017) · International Journal of Advanced Nursing Studies · doi:10.14419/ijans.v6i1.7415 · Cited by 24
Insomnia and intellect mask the positive link between schizotypal traits and creativity
Polner, B., Simor, P., & Kéri, S. (2018) · PeerJ · doi:10.7717/peerj.5615 · Cited by 29
“The AIS is a reliable and valid instrument for the 314 measurement of subjective sleep quality and complaints of insomnia (Soldatos et al., 2000).”
Method
Sleep severity and fatigue manifestations in relation to the doctor–patient relationship
Azzez, S. S., Abdulah, D. M., Piro, R. S., & Alhakem, S. S. M. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.02.015 · Cited by 24
Association of Depression and Excessive Daytime Sleepiness among Sleep-Deprived College Freshmen in Northern Taiwan
Tsou, M.-T., & Chang, B. C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173148 · Cited by 24
“The Athens Insomnia Scale (AIS), designed to assess the severity of insomnia, uses diagnostic criteria from the International Classification of Diseases (ICD-10) with eight items evaluating sleep onset, night and early-morning waking, sleep time, sleep quality, frequency and duration of complaints, distress caused by…”
Method

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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