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
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MethodInfluential
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Method
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BackgroundMethod
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Method
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Method
Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery
Tóth, K., Szabó, A., Nagy, Á., Szabó, D., Szécsi, B., Eke, C., Sándor, Á. D., Susánszky, É., Holndonner-Kirst, E., Merkely, B. P., et al. (2021) · Annals of Palliative Medicine · doi:10.21037/apm-21-1015 · Cited by 15
“AIS-5 is ≥4 was the cut-off score, which is indicating possible insomnia (35).”
Background
Genetic Variants of the BAFF Gene and Risk of Fatigue Among Patients With Primary Sjögren’s Syndrome
Flessa, C., Zampeli, E., Evangelopoulos, M., Natsis, V., Bodewes, I. L. A., Huijser, E., Versnel, M. A., Moutsopoulos, H. Μ., & Mavragani, C. P. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.836824 · Cited by 16
“Psychological features of primary SS patients (Greek cohort) were assessed using the following self-administered psychometric questionnaires: 1) State-Trait Anxiety Inventory (STAI) (48), a questionnaire used to assess anxiety either as a personality feature or as a current condition; 2) Eysenck Personality Questionna…”
MethodInfluential
Excitatory versus inhibitory impairments in insomnia patients: An ERP study
Cortoos, A., Valck, E. D., Pattyn, N., Maîresse, O., & Cluydts, R. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.03.004 · Cited by 16
Psychometric analysis of the Pittsburgh insomnia rating scale among university population of poor sleepers in India
Veqar, Z., Hussain, M., & Moiz, J. A. (2014) · North American Journal of Medical Sciences · doi:10.4103/1947-2714.131238 · Cited by 16
“There are a few tools available like Insomnia severity index (ISI),[13] Pittsburgh sleep quality index (PSQI),[14] Athens insomnia scale,[15] Oviedo sleep questionnaire[16] etc.”
Method
Is uremic pruritus still an important clinical problem in maintenance hemodialysis patients?
Heisig, M., Reich, A., & Szepietowski, J. C. (2015) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.13524 · Cited by 16
Association of physical activity with sleep health: A systematic review
Wendt, A. T., Flores, T. R., Crochemore‐Silva, I., & Wehrmeister, F. C. (2019) · Revista Brasileira de Atividade Física & Saúde · doi:10.12820/rbafs.23e0057 · Cited by 18
Insight into the relationship between sleep characteristics and anxiety: A cross-sectional study in indigenous and minority populations in northeastern Greece
Serdari, A., Manolis, A., Tsiptsios, D., Vorvolakos, T., Terzoudi, A., Nena, E., Tsamakis, K., Steiropoulos, P., & Tripsianis, G. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113361 · Cited by 16
Cross-sectional Study on Relationship between Constipation and Medication in Consideration of Sleep Disorder
Ueki, T., Nagai, K., MIZUKAMI, Y., Takahashi, A., Ooe, N., Nakashima, M. N., Nishida, K., Nakamura, J., & Nakashima, M. (2011) · YAKUGAKU ZASSHI · doi:10.1248/yakushi.131.1225 · Cited by 16
Evaluation of Efficacy of Mirtazapine on Pruritus and Serum Histamine and Serotonin Levels in Patients Undergoing Hemodialysis: A Before–After Pilot Clinical Trial
Mehrpooya, M., Gholyaf, M., Yasrebifar, F., Mohammadi, Y., & Sheikh, V. (2020) · International Journal of Nephrology and Renovascular Disease · doi:10.2147/ijnrd.s246393 · Cited by 15
Restless Legs Syndrome masquerades as chronic insomnia
Bonakis, A., Androutsou, A., Koloutsou, M. E., & Vagiakis, E. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.06.003 · Cited by 15
Age and Gender Effects On the Association of Sleep Insufficiency With Hypertension Among Adults in Greece
Tsiptsios, D., Matziridis, A., Ouranidis, A., Triantafyllis, A. S., Terzoudi, A., Tsamakis, K., Rizos, E. N., Mueller, C., Steiropoulos, P., Vorvolakos, T., et al. (2021) · Future Cardiology · doi:10.2217/fca-2020-0198 · Cited by 15
A Randomized Controlled Trial on Pleurotus eryngii Mushrooms with Antioxidant Compounds and Vitamin D2 in Managing Metabolic Disorders
Kleftaki, S.-A., Amerikanou, C., Gioxari, A., Lantzouraki, D. Z., Sotiroudis, G. T., Tsiantas, K., Tsiaka, T., Tagkouli, D., Tzavara, C. K., Lachouvaris, L., et al. (2022) · Antioxidants · doi:10.3390/antiox11112113 · Cited by 15
“A higher score indicates greater severity of insomnia symptoms [24].”
Background
Exploring the associations between behavioral health risk factors, abnormal eating attitudes and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020
Liu, J., Teng, Z., Chen, Z., Wei, Z., Zou, T., Qin, Y., Yuan, H., Liu, M., Chen, J., Tang, H., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1000821 · Cited by 16
“The Athens Insomnia Scale (AIS) was adopted to assess the symptoms of insomnia in participants by evaluating eight factors; of these, the first five factors are related to nocturnal sleep, and the rest are related to daytime dysfunction (21).”
Method
Dietary Patterns, Cardiometabolic and Lifestyle Variables in Greeks with Obesity and Metabolic Disorders
Amerikanou, C., Kleftaki, S.-A., Valsamidou, E., Tzavara, C. K., Gioxari, A., & Kaliora, A. C. (2022) · Nutrients · doi:10.3390/nu14235064 · Cited by 15
“Sleep quality was evaluated by the Athens Insomnia Scale (AII), consisting of 10 items on nocturnal sleep problems and daytime dysfunction [14].”
Method
The effect of preoperative sleep quality on the target plasma concentration of propofol and postoperative sleep in patients undergoing painless gastroscopy
Qiu, Y., Hou, H., Zhang, J., Wang, X., Wang, L., Wu, Y., & Deng, L. (2023) · BMC Anesthesiology · doi:10.1186/s12871-022-01957-2 · Cited by 15
“The AIS is a standardized self-report questionnaire that evaluates sleep-related problems [7].”
Background
The prevalence and risk factors of burnout and its association with mental issues and quality of life among hungarian postal workers: a cross-sectional study
Kovács, M., Muity, G., Szapáry, Á., Nemeskéri, Z., Váradi, I., Kapus, K., Tibold, A., Zalayné, N. M., Horváth, L., & Fehér, G. (2023) · BMC Public Health · doi:10.1186/s12889-023-15002-5 · Cited by 15
“A score of 10 indicates clinically significant insomnia [25].”
Background
Sleep disruption in older surgical patients and its important implications
Butris, N., Tang, E., He, D., Wang, D., & Chung, F. F. (2023) · International Anesthesiology Clinics · doi:10.1097/aia.0000000000000391 · Cited by 15
Use of Caffeine-Containing Energy Drinks by Japanese Middle School Students: A Cross-Sectional Study of Related Factors
Yamasaki, S., Kawasaki, H., & Cui, Z. (2023) · Nutrients · doi:10.3390/nu15051275 · Cited by 16
“To measure sleep, we used the Athens Insomnia Scale [29].”
Nocturia and Sleep in Parkinson’s Disease
Diaconu, Ș., Irincu, L., Ungureanu, L., Ţînţ, D., & Falup‐Pecurariu, C. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13071053 · Cited by 15
“Another instrument for evaluating insomnia is the Athens Insomnia Scale (AIS), which consists of eight items regarding the components of insomnia (first five questions) and their consequences (last three items) [30].”
Method
The association of problematic usage of the internet with burnout, depression, insomnia, and quality of life among Hungarian high school students
Feher, A., Fejes, É., Kapus, K., Jancsák, C., Nagy, G. D., Horváth, L., Tibold, A., & Fehér, G. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1167308 · Cited by 18
“Reaching >6 points means the presence of insomnia, while >10 points means clinically significant, severe insomnia (2, 3, 54, 55).”
Background
Network analysis to estimate central insomnia symptoms among daytime workers at-risk for insomnia
Takano, Y., Ibata, R., Nakano, N., & Sakano, Y. (2023) · Scientific Reports · doi:10.1038/s41598-023-43802-7 · Cited by 15
Association between electroencephalogram-based sleep characteristics and physical health in the general adult population
Iwagami, M., Seol, J., Hiei, T., Tani, A., Chiba, S., Kanbayashi, T., Kondo, H., Tanaka, T., & Yanagisawa, M. (2023) · Scientific Reports · doi:10.1038/s41598-023-47979-9 · Cited by 15
“Focusing on sBP, we conducted a subgroup analysis using the self-reported AIS, a commonly-used subjective sleep quality scale 17 .”
BackgroundMethodResultInfluential
Can rheumatoid arthritis affect sleep in Egyptian patients?
Elazeem, M. I. A., & Salem, M. N. (2017) · The Egyptian Rheumatologist · doi:10.1016/j.ejr.2017.06.001 · Cited by 15
The efficacy of the traditional Chinese medicine Juanbi pill combined with methotrexate in active rheumatoid arthritis: study protocol for a randomized controlled trial
Wang, Q., Wang, Y., Jia, Q.-Y., Liu, L., Xu, C.-Q., Wang, X., Yao, M., Cui, X.-J., Shi, Q., Wang, Y., et al. (2018) · Trials · doi:10.1186/s13063-018-2555-1 · Cited by 16
Tinnitus: psychosomatische Aspekte
Boecking, B., Brüeggemann, P., & Mazurek, B. (2019) · HNO · doi:10.1007/s00106-019-0609-7 · Cited by 15
The association between self-reported sleep dissatisfaction after the Great East Japan Earthquake, and a deteriorated socioeconomic status in the evacuation area: the Fukushima Health Management Survey
Zhang, W., Ohira, T., Maeda, M., Nakano, H., Iwasa, H., Yasumura, S., Ohtsuru, A., Harigane, M., Suzuki, Y., Horikoshi, N., et al. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.09.004 · Cited by 17
“version of Athens Insomnia Scale (AIS-SJ) which had been used previously (23, 24).”
Method
Insomnia and caregiver burden in chronic pain patients: A cross-sectional clinical study
Yamaguchi, M., Yamada, K., Iseki, M., Karasawa, Y., Murakami, Y., Enomoto, T., Kikuchi, N., Chiba, S., Hara, A., Yamaguchi, K., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0230933 · Cited by 14
“The Athens Insomnia Scale (AIS) full version is an eight-item self-report questionnaire that measures the intensity of sleep difficulty [24,31] in accordance with the International Statistical Classification of Disease and Related Health Problems 10th Revision (ICD10) diagnostic criteria.”
BackgroundMethod
Cognitive factors associated with locomotive syndrome in chronic pain patients: A retrospective study
Tsuji, H., Tetsunaga, T., Tetsunaga, T., Misawa, H., Nishida, K., & Ozaki, T. (2020) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2020.08.007 · Cited by 14
Impact of the Great East Japan Earthquake on the Employment Status and Mental Health Conditions of Affected Coastal Communities
片柳, 光., Seto, M., Nakaya, N., Nakamura, T., Tsuchiya, N., Narita, A., Kogure, M., Sugawara, Y., Kodaka, A., Utsumi, Y., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218130 · Cited by 15
“As there was a significant difference in the age of subjects that made up each group, the analysis of covariance (ANCOVA) was applied to the comparisons of AIS and IES-R scores among the three groups using age as a confounding factor.”
BackgroundMethodInfluential
Are lifestyle factors significantly associated with self-rated health among Japanese female healthcare students?
Ohtsuki, M., Wakasugi, Y., Narukawa, T., Uehara, S., & Ohkubo, T. (2021) · BMC Public Health · doi:10.1186/s12889-021-10435-2 · Cited by 15
Mediating Roles of Cognitive Complaints on Relationships between Insomnia, State Anxiety, and Presenteeism in Japanese Adult Workers
Toyoshima, K., Inoue, T., Shimura, A., Uchida, Y., Masuya, J., Fujimura, Y., Higashi, S., & Kusumi, I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094516 · Cited by 16
“The Athens Insomnia Scale (AIS) was used to evaluate the insomnia severity [36,37].”
Method
Estimating the cumulative risk of postnatal depressive symptoms: the role of insomnia symptoms across pregnancy
Pietikäinen, J. T., Härkänen, T., Polo‐Kantola, P., Karlsson, H., Paunio, T., Karlsson, L., & Paavonen, E. J. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02101-0 · Cited by 15
“The Athens Insomnia Scale (AIS) is a self-report questionnaire for sleep disturbances based on ICD-10 criteria [28].”
Method
Quasi-cluster randomized trial of a six-month low-intensity group-based resistance exercise for hemodialysis patients on depression and cognitive function: a 12-month follow-up
Nakamura‐Taira, N., Horikawa, N., Oka, F., Igarashi, Y., Kobayashi, S., Kato, S., Enomoto, T., Kimura, H., Watanabe, Y., Kumada, T., et al. (2021) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2021.1966302 · Cited by 16
Can Tongue Acupuncture Enhance Body Acupuncture? First Results from Heart Rate Variability and Clinical Scores in Patients with Depression
Shi, X., Wang, H., Wang, L., Zhao, Z., Litscher, D., Tao, J., Gaischek, I., Sheng, Z., & Litscher, G. (2014) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2014/329746 · Cited by 15
“HAM-A: Hamilton Anxiety Rating Scale [7]; AIS: Athens Insomnia Scale [8]; HRSD: Hamilton Rating Scale for Depression [9]; BPsys: systolic blood pressure; BPdia: diastolic blood pressure; and n.”
MethodInfluential
Associations between walking parameters and subsequent sleep difficulty in older adults: A 2-year follow-up study
Chen, L., Fox, K. R., Sun, W., Tsai, P.-S., Ku, P., & Chu, D. (2017) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2017.01.007 · Cited by 16
“A higher score indicates greater sleep difficulty.(26) The cut-off point for defining sleep difficulty (insomnia symptoms) for the Chinese version of AIS-5 is suggested to be 5.”
Background
Evaluation of a self-regulation based psycho-educational pilot intervention targeting children and adolescents with epilepsy in Greece
Rizou, I., Gucht, V. D., Papavasiliou, A. S., & Stan Maes, A. (2017) · Seizure · doi:10.1016/j.seizure.2017.06.014 · Cited by 15
“Sleep problems were assessed with the validated Athens Insomnia Scale (AIS) [27,28].”
Method
Association between housing type and γ-GTP increase after the Great East Japan Earthquake
Murakami, A., Sugawara, Y., Tomata, Y., Sugiyama, K., Kaiho, Y., Tanji, F., & Tsuji, I. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.07.020 · Cited by 15
Sleep questionnaires for the screening of obstructive sleep apnea in patients with type 2 diabetes mellitus compared with non‐diabetic patients
Pataka, A., Kalamaras, G., Daskalopoulou, E., & Argyropoulou, P. (2018) · Journal of Diabetes · doi:10.1111/1753-0407.12835 · Cited by 15
Efficacy of stress management program for depressive patients with advanced head and neck cancer: A single-center pilot study
Ichikura, K., Nakayama, N., Matsuoka, S., Ariizumi, Y., Sumi, T., Sugimoto, T., Fukase, Y., Murayama, N., Tagaya, H., Asakage, T., et al. (2020) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2020.06.003 · Cited by 15
Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study
Sánchez‐Martínez, V., Buigues, C., Navarro-Martínez, R., García‐Villodre, L., Karoui, N. J. E., Serrano-Carrascosa, M., Rubio‐Briones, J., & Cauli, O. (2021) · Life · doi:10.3390/life11030227 · Cited by 15
The efficacy of Cognitive-Behavioural Therapy (CBT) as related to sleep quality and hyperarousal level in the treatment of primary insomnia.
Gałuszko‐Węgielnik, M., Jakuszkowiak‐Wojten, K., Wiglusz, M. S., Cubała, W. J., & Landowski, J. (2012) · PubMed · Cited by 15
Musculoskeletal Pain is Associated With New-Onset Psychological Distress in Survivors of the Great East Japan Earthquake
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Koide, M., Itaya, N., Yoshida, S., Sogi, Y., Yano, T., et al. (2018) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2018.57 · Cited by 15
Association of Family Income with Health Indices and Healthcare Utilization in a Large Sample of Residents in Northern Greece
Zissimopoulou, O., Leontidou, E., Tsiptsios, D., Manolis, A., IOANNIDES, D., Trypsiani, I., Steiropoulos, P., Constantinidis, T. C., Tripsianis, G., & Nena, E. (2020) · MAEDICA – a Journal of Clinical Medicine · doi:10.26574/maedica.2020.15.4.490 · Cited by 16
Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis
Grande, M. R. L., Jackson, A. C., Beauchamp, A., Kerr, D. C., & Driscoll, A. L. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.02.021 · Cited by 14
Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis
Chiò, A., Canosa, A., Calvo, A., Moglia, C., Cicolin, A., & Mora, G. (2021) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1984883 · Cited by 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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