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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Background
A Systematic Review of the Impact of Wildfires on Sleep Disturbances
Isaac, F., Toukhsati, S. R., Benedetto, M. D., & Kennedy, G. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910152 · Cited by 25
Prevalence of Psychological Distress and Associated Factors in Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study
Tanji, F., & Kodama, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910358 · Cited by 21
“Insomnia was measured using the Athens Insomnia Scale (AIS) [24,25].”
MethodInfluential
Oxidative Stress Risk Is Increased with a Sedentary Lifestyle during Aging in Mexican Women
Sánchez-Rodrı́guez, M. A., Zacarías-Flores, M., Correa‐Muñoz, E., Arronte-Rosales, A., & Mendoza-Núñez, V. M. (2021) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2021/9971765 · Cited by 20
Assessment of Insomnia Symptoms, Quality of Life, Daytime Sleepiness, and Psychoactive Substance Use among Polish Students: A Cross-Sectional Online Survey for Years 2016–2021 before and during COVID-19 Pandemic
Babicki, M., Piotrowski, P., & Mastalerz–Migas, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11082106 · Cited by 21
Patient-reported sleep outcomes in randomized-controlled trials in persons with substance use disorders: A systematic review
Huhn, A. S., Ellis, J. D., Dunn, K. E., Sholler, D. J., Tabaschek, P., Burns, R., & Strain, E. C. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109508 · Cited by 20
A Social Media Outage Was Associated with a Surge in Nomophobia, and the Magnitude of Change in Nomophobia during the Outage Was Associated with Baseline Insomnia
Jahrami, H., Fekih‐Romdhane, F., Saif, Z., Bragazzi, N. L., Pandi-Perumal, S. R., BaHammam, A. S., & Vitiello, M. V. (2022) · Clocks & Sleep · doi:10.3390/clockssleep4040040 · Cited by 24
“Eight items in the questionnaire measure sleep onset, early morning awakenings, sleep time, sleep quality, complaints, the stress associated with insomnia, and interference with daily activities [51].”
BackgroundMethodInfluential
The impact of physical activity on objective sleep of people with insomnia
Ferreira, M. F., Bos, S. C., & Macedo, A. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.115019 · Cited by 24
Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership
Cooke, M. E., Potter, K. W., Jashinski, J., Pascale, M. P., Schuster, R. M., Tervo‐Clemmens, B., Hoeppner, B. B., Pachas, G. N., Evins, A. E., & Gilman, J. M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1083334 · Cited by 21
Chios mastiha essential oil exhibits antihypertensive, hypolipidemic and anti-obesity effects in metabolically unhealthy adults - a randomized controlled trial
Gioxari, A., Amerikanou, C., Valsamidou, E., Kleftaki, S.-A., Tzavara, C. K., Kalaitzopoulou, A., Stergiou, I., Smyrnioudis, I., & Kaliora, A. C. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.106821 · Cited by 22
Tomato juice intake increases resting energy expenditure and improves hypertriglyceridemia in middle-aged women: an open-label, single-arm study
Hirose, A., Terauchi, M., Tamura, M., Akiyoshi, M., Owa, Y., Kato, K., & Kubota, T. (2015) · Nutrition Journal · doi:10.1186/s12937-015-0021-4 · Cited by 20
“The internal consistency and test-retest reliability of the AIS was previously confirmed [24].”
MethodInfluential
Physiological and psychological factors associated with onset of high-altitude headache in Chinese men upon acute high-altitude exposure at 3700 m
Guo, W.-Y., Bian, S., Zhang, J., Li, Q., Yu, J., Chen, J., Tang, C.-F., Rao, R., Yu, S., Jin, J., et al. (2016) · Cephalalgia · doi:10.1177/0333102416646761 · Cited by 20
“Baseline diameter of the left ventricle (LVD), Athens Insomnia Scale (AIS) and confusion score were independent predictors for HAH.”
Method
Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Sato, M., Kanazawa, K., Koide, M., Itaya, N., Tsuchiya, M., Tsuji, I., et al. (2016) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2016.11.003 · Cited by 20
Obesity is associated with a higher prevalence of musculoskeletal pain in middle-aged women
Blümel, J. E., Arteaga, E., Mezones‐Holguín, E., Zúñiga, M. C., Witis, S., Vallejo, M. S., Tserotas, K., Sánchez, H., Onatra, W., Ojeda, E., et al. (2017) · Gynecological Endocrinology · doi:10.1080/09513590.2016.1269741 · Cited by 20
“Insomnia was defined as a score 6 in the Athens Insomnia Scale [18].”
Method
Higher Incidence of Sleep Disturbance among Survivors with Musculoskeletal Pain after the Great East Japan Earthquake: A Prospective Study
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Koide, M., Itaya, N., Yoshida, S., Sogi, Y., Yano, T., et al. (2018) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.244.25 · Cited by 20
“Following the previous studies, psychological distress and social isolation were defined as a score of ≥ 10/24 on the K6 (Suzuki et al. 2014) and < 12/30 on the LSNS-6 (Sone et al. 2016), respectively.”
BackgroundMethodInfluential
Gender differences in the relationship between alcohol consumption and insomnia in the northern Chinese population
Guo, Y., Hu, H., Liu, Y., Leng, Y., Gao, X., Cui, Q., Chen, J., Geng, B., & Zhou, Y. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207392 · Cited by 20
Epigenetic dysregulation of genes related to synaptic long-term depression among adolescents with depressive disorder and sleep symptoms
Ämmälä, A., Urrila, A. S., Lahtinen, A., Santangeli, O., Hakkarainen, A., Kantojärvi, K., Castaneda, A. E., Lundbom, N. M. I., MARTTUNEN, M. J., & Paunio, T. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.01.050 · Cited by 21
The effectiveness of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes in patients with laryngectomy: Randomized controlled trial
Yang, Y., Zhang, H., Li, Y., Liu, Z., Liu, S., Li, X., Fan, G., Xu, Y. J., & Wang, B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.068 · Cited by 20
The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients
Wei, C., Chung, T.-C., Wu, S.-C., Chung, C.-F., & Wu, W.-P. (2011) · Renal Failure · doi:10.3109/0886022x.2010.541578 · Cited by 20
Mindfulness-based intervention for prodromal sleep disturbances in older adults: Design and methodology of a randomized controlled trial
Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.06.013 · Cited by 21
“Insomnia symptom will be measured with the Athens Insomnia Scale (AIS) [33], a validated 8-item self-report questionnaire that assesses sleep difficulty.”
Depression and Insomnia Are Closely Associated with Thyroid Hormone Levels in Chronic Hepatitis B
Huang, X., Zhang, H., Qu, C., Liu, Y., Bian, C., & Xu, Y. (2019) · Medical Science Monitor · doi:10.12659/msm.914444 · Cited by 19
Occupational Burnout and Insomnia in Relation to Psychological Resilience Among Greek Nurses in the Post-Pandemic Era
Sikaras, C., Pachi, A., Alikanioti, S., Ilias, Ι., Sideri, E. P., Tselebis, A., & Παναγιώτου, Α. (2025) · Behavioral Sciences · doi:10.3390/bs15020126 · Cited by 29
“The Greek version of the AIS has demonstrated good psychometric properties (Soldatos et al., 2000; Tselebis et al., 2020).”
Mobile sensor-based community gaming for improving vocational students’ sleep and academic outcomes
Wang, J.-S., Gamble, J. H., & Yang, Y.-T. C. (2020) · Computers & Education · doi:10.1016/j.compedu.2020.103812 · Cited by 19
Association of CRP genetic variation with symptomatology, cognitive function, and circulating proinflammatory markers in civilian women with PTSD
Otsuka, T., Hori, H., Yoshida, F., Itoh, M., Lin, M., Niwa, M., Ino, K., Imai, R., Ogawa, S., Matsui, M., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.045 · Cited by 20
A cross-sectional epidemiological study of the relationship between sleep duration, quality, and rhythm and presenteeism in workers
Itani, O., Kaneita, Y., Otsuka, Y., Tokiya, M., Jike, M., Matsumoto, Y., Nakagome, S., & Kinoshita, Y. (2021) · Sleep and Biological Rhythms · doi:10.1007/s41105-021-00339-4 · Cited by 19
“The AIS is a questionnaire designed to assess the severity of insomnia and is based on the International Classification of Disease, Tenth Revision [15].”
MethodInfluential
Effort Reward Imbalance and Insomnia Among Greek Healthcare Personnel During the Outbreak of COVID-19
Tzenetidis, V., Papathanasiou, I., Tzenetidis, N., Nikolentzos, A., Sarafis, P., & Malliarou, M. M. (2021) · Materia Socio Medica · doi:10.5455/msm.2021.33.124-130 · Cited by 19
“The last three items correspond to daytime symptoms which are the result of nocturnal sleep difficulties (14).”
Background
Acupuncture for adult lung cancer of patient-reported outcomes: A systematic review and meta-analysis
Xi, Z., Wei, X., Ye, Z., Wang, K., & Zhou, J. J. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.921151 · Cited by 19
“One RCT (44) using AIS showed that AIS scores in the observation group and the control group were not statistically significant (P>0.05) (MD -0.17, 95%CI, -1.93 to 1.59, P=0.85) (Table 5).”
MethodInfluential
Adjuvant aromatase inhibitor treatment worsens depressive symptoms and sleep quality in postmenopausal women with localized breast cancer: A one-year follow-up study
García-Sánchez, J., Mafla-España, M. A., Torregrosa, M. D., & Cauli, O. (2022) · The Breast · doi:10.1016/j.breast.2022.11.007 · Cited by 22
The serial mediating effects of social isolation and resilience on the relationship between fear of dementia and insomnia in community‐dwelling older adults
Dai, H., Qin, J., Huang, R., Sun, D., & Zhang, Q. (2023) · Journal of Advanced Nursing · doi:10.1111/jan.15567 · Cited by 19
Daily rhythms, light exposure and social jetlag correlate with demographic characteristics and health in a nationally representative survey
Ujma, P. P., Horváth, C. G., & Bódizs, R. (2023) · Scientific Reports · doi:10.1038/s41598-023-39011-x · Cited by 21
Insomnia és elalvást segítő szokások felmérése felnőttek körében
Fusz, K., Faludi, B., Pusztai, D., Sebők, N., & Olah, A. (2016) · Orvosi Hetilap · doi:10.1556/650.2016.30593 · Cited by 22
Affective Temperaments, Mood, and Insomnia Symptoms in a Nonclinical Sample
Oniszczenko, W., Rzeszutek, M., & Stanisławiak, E. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1357121 · Cited by 19
Evidence Base Update on Assessing Sleep in Youth
Meter, A. V., & Anderson, E. A. (2020) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2020.1802735 · Cited by 21
Health behavior, sleep quality and subjective health status among Hungarian nurses working varying shifts
Fusz, K., Kívés, Z., Pakai, A., Kutfej, N., Deák, A., & Olah, A. (2021) · Work · doi:10.3233/wor-203366 · Cited by 19
“The cumulative score of the Athens Insomnia Scale [34] used generally in the assessment of sleep quality andtheBSWSQ-Htotalscoreshowsasigniﬁcantcor-relation( p < 0.001; r = 0.61).”
Influential
The MedWeight study: Design and preliminary results
Karfopoulou, E., Anastasiou, C. A., Hill, J. O., & Yannakoulia, M. (2014) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-140022 · Cited by 19
“Moreover, sleep quality is assessed by the Athens Insomnia Scale – AIS [32], which examines the frequency of sleep disturbances such as difficulty falling asleep and mid-sleep awakenings.”
Method
Compression of the optic chiasm is associated with permanent shorter sleep duration in patients with pituitary insufficiency
Borgers, A. J., Romeijn, N., Someren, E. J. W. V., Fliers, E., Alkemade, A., & Bisschop, P. H. L. T. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04053.x · Cited by 19
Sleep disturbance as a proximal predictor of suicidal intent in recently hospitalized attempters
Ferentinos, P. P., Porichi, E., Christodoulou, C., Dikeos, D. G., Papageorgiou, C., & Douzenis, A. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.10.021 · Cited by 19
“Temporally proximal insomnia (ie, reported during the two weeks preceding the attempt) was retrospectively assessed with the eight-item Athens Insomnia Scale (AIS) [20]; a score of six or higher suggests a diagnosis of insomnia [21].”
Method
Regular consumption of HolisFiit, a polyphenol-rich extract-based food supplement, improves mind and body well-being of overweight and slightly obese volunteers: a randomized, double-blind, parallel trial
Romain, C., Alcaráz, P. E., Chung, L. H., & Cases, J. (2017) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2017.1292221 · Cited by 19
“Subjective sleep complaints and corresponding impacts on well-being and functioning were assessed with the 8-item Athens Insomnia Scale (AIS-8) (Soldatos et al. 2000).”
Method
Sleep and slow-wave activity in depressed adolescent boys: a preliminary study
Santangeli, O., Porkka‐Heiskanen, T., Virkkala, J., Castaneda, A. E., MARTTUNEN, M. J., Paunio, T., & Urrila, A. S. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.06.029 · Cited by 20
“The shorter TST observed in our sample of depressed adolescents as compared to healthy controls may be due to insomnia symptoms (difficulties in falling asleep, disrupted sleep continuity, and earlymorning awakenings), which is evidenced by significantly higher AIS scores in depressed boys compared to controls.”
MethodInfluential
A double-blind intervention trial in healthy women demonstrates the beneficial impact on Bifidobacterium with low dosages of prebiotic galacto-oligosaccharides
Looijesteijn, E., Schoemaker, M. H., van den Belt, M., Hester, E. R., Kortman, G. A. M., van Dongen, M. V., & Nauta, A. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1440319 · Cited by 19
“This is a self-reported, psychometric, validated questionnaire designed to quantify sleep difficulty based on the ICD-10 criteria (39).”
Method
Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study
Fang, J., Liang, H., Chen, M., Zhao, Y., & Wei, L. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05431-1 · Cited by 19
“…Index, BI) [18], nutritional status (evaluated by the Nutritional Risk Screening 2002, NRS2002) [19], pain (measured by the Numerical Rating Scale, NRS) [20], sleep quality (measured by the Athens Insomnia Scale, AIS) [21], and depression (measured by the Patient Health Questionnaire, PHQ) [22].”
Method
Bedtime repetitive negative thinking moderates the relationship between psychological stress and insomnia
Benham, G. (2021) · Stress and Health · doi:10.1002/smi.3055 · Cited by 19
Clinical Profile and Aspects of Differential Diagnosis in Patients with ME/CFS from Latvia
Krūmiņa, A., Vecvagare, K., Svirskis, Š., Grāvelsiņa, S., Nora-Krūkle, Z., Gintere, S., & Murovska, M. (2021) · Medicina · doi:10.3390/medicina57090958 · Cited by 18
“Regarding sleep disturbances, we included a self-reported questionnaire—Athens Insomnia Scale 8 [30]—to assess insomnia symptoms, which included the evaluation”
Method
Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy and the Three Good Things Exercise for Insomnia: 3-Arm Randomized Controlled Trial
Sato, D., Sekizawa, Y., Sutoh, C., Hirano, Y., Okawa, S., Hirose, M., Takemura, R., & Shimizu, E. (2021) · Journal of Medical Internet Research · doi:10.2196/28747 · Cited by 19
“The AIS is a self-administered questionnaire for assessing the severity of insomnia [14].”

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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