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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Miranda, P., McCluskey, N. J., Silber, B. J., Pohle, C. M. D. V., & Bainum, C. K. (2009) · Psi Chi Journal of Psychological Research · doi:10.24839/1089-4136.jn14.2.79 · Cited by 9
Relationship between working hours and sleep quality with consideration to effect modification by work style: a community-based cross-sectional study
Yoshida, A., Asakura, K., Imamura, H., Mori, S., Sugimoto, M., Michikawa, T., & Nishiwaki, Y. (2024) · Environmental Health and Preventive Medicine · doi:10.1265/ehpm.23-00252 · Cited by 13
Association of childhood trauma, social support, cognition, and suicidality in females with bipolar disorder
Yang, M., Li, J., Fu, Y., Wang, G., Liu, M., Chen, J., & Liu, J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05672-9 · Cited by 11
“It is simple, concise and easy to use, with a total of 8 items, each divided into four levels: 0, 1, 2, and 3, indicating from none to severe [30].”
Background
Treatment effect heterogeneity of cognitive behavioral therapy for insomnia – A meta-analysis
Steinmetz, L., Simon, L., Baumeister, H., Spiegelhalder, K., & Terhorst, Y. (2024) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2024.101966 · Cited by 11
Nonrestorative sleep and its association with insomnia severity, sleep debt, and social jetlag in adults: Variations in relevant factors among age groups
Takano, Y., Ibata, R., Machida, N., & Okajima, I. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.07.008 · Cited by 9
Sleep Patterns and Tryptophan Consumption among Students at Spanish Universities: The Unihcos Project
Morales‐Suárez‐Varela, M., Amezcua‐Prieto, C., Peraita‐Costa, I., Mateos-Campos, R., Ayán, C., Ortiz-Moncada, R., & Fernández‐Villa, T. (2024) · Nutrients · doi:10.3390/nu16142376 · Cited by 11
“…several days, most days, every day); Wake up early (never, some days, several days, most days, every day); insomnia (“Do you suffer from insomnia?” yes, no); Athens Insomnia Scale [55,56] (no problem, slightly delayed, markedly delayed, very delayed or did not sleep at all, total score: 0–24).”
Background
Rationale and design of a randomized placebo-controlled nutritional trial embracing a citizen science approach
van de Put, M., van den Belt, M., de Wit, N. J. W., & Kort, R. (2024) · Nutrition Research · doi:10.1016/j.nutres.2024.07.008 · Cited by 11
“…at baseline, weeks 2, 8, and 21: the digestion-associated quality of life questionnaire, to measure digestion-associated quality of life [ 62 ], the Athens insomnia scale, to measure sleep quality [ 63 ], and the World Health Organization five well-being index, to measure well-being [ 64 ].”
The Effectiveness of Cognitive Behavioral Therapy on Insomnia Severity Among Menopausal Women: A Scoping Review
Ntikoudi, A., Owens, D. A., Spyrou, A., Evangelou, E., & Vlachou, E. D. (2024) · Life · doi:10.3390/life14111405 · Cited by 15
Assessing the impact of sleep quality on physical function in Chinese older inpatient
Chang, X., Yuan, Y., Liao, J., Zhou, Q., & Wu, W. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06019-z · Cited by 9
“This cut-off has been shown to have high specificity and sensitivity for distinguishing poor sleepers and healthy controls [21].”
Prevalence and associated risk factors for depression, anxiety, insomnia, and loneliness among the geriatric population in Bangladesh: a cross-sectional study
Rahman, M., Khan, M., Fattah, T., Tasnim, Z., Das, P. R., Prattay, K. M. R., Islam, M. S., & Islam, M. R. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07500-0 · Cited by 9
“The presence of insomnia symptoms was defined by a score of ≥ 6, and the entire score was subsequently classified into four tiers: cumulative scores of 0–5, 6–9, 10–15, and 16–24, corresponding to no, mild, moderate, and severe insomnia, respectively [24].”
Mirtazapine for Methamphetamine Use Disorder
McKetin, R., SHOPTAW, S. J., Saunders, L., Nguyen, L., Clare, P. J., Dore, G. J., Turner, A., Dean, O. M., Kelly, P. J., Arunogiri, S., et al. (2026) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2026.0159 · Cited by 9
Health behavior, sleep quality and subjective health status of foreign students in Hungary
Pusztai, D., Rozmann, N., Horváth, É., Szunomár, S., & Fusz, K. (2019) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2019.06.002 · Cited by 9
Large Questionnaire Survey on Sleep Duration and Insomnia Using the TV Hybridcast System by Japan Broadcasting Corporation (NHK)
Ito, K., Kadotani, H., Okajima, I., Ubara, A., Ichikawa, M., Omichi, C., Miyamoto, T., Matsuda, A., Sumi, Y., & Kitagawa, H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052691 · Cited by 9
“The AIS is an eight-item self-reporting questionnaire that measures the intensity of sleep difficulties according to the International Statistical Classification of Disease and Related Health Problems 10th Revision (ICD-10) diagnostic criteria for insomnia [19].”
BackgroundMethod
Central Aspects of Pain in Rheumatoid Arthritis (CAP-RA): protocol for a prospective observational study
Ifesemen, O. S., McWilliams, D. F., Ferguson, E., Wakefield, R. J., Akin-Akinyosoye, K., Wilson, D., Platts, D., Ledbury, S., & Walsh, D. A. (2021) · BMC Rheumatology · doi:10.1186/s41927-021-00187-2 · Cited by 12
“Depression and anxiety will be measured using the Hospital Anxiety and Depression Scale (HADS) [40]; functional ability,; and sleep, by the Athens Insomnia Scale (ASC) [41].”
Method
Impact of type of reconstructed residence on social participation and mental health of population displaced by disasters
Suzuki, T., Akaishi, T., Nemoto, H., Utsumi, Y., Seto, M., Usukura, H., Kunii, Y., Sugawara, Y., Nakaya, N., Nakamura, T., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-00913-3 · Cited by 9
Overnight emotional inertia in relation to depressive symptomatology and subjective sleep quality
Frérart, L., Bilsen, L., Dejonckheere, E., & Kuppens, P. (2022) · SLEEP Advances · doi:10.1093/sleepadvances/zpac048 · Cited by 11
“Additionally, the first beep of the day asked to indicate their sleep duration on a slider ranging from 1 (‘Enough’) to 4 (“Very little/not at all”) and sleep quality on a slider ranging from 1 (‘Good’) to 4 (“Very bad/not at all”), both derived from the Athens Insomnia Scale (AIS) [27].”
Method
The Insomnia Severity Index: Factor Structure and Measurement and Structural Invariance across Perinatal Time Points
Shinohara, E., Hada, A., Minatani, M., Wakamatsu, M., & Kitamura, T. (2023) · Healthcare · doi:10.3390/healthcare11081194 · Cited by 9
“There are several insomnia screening questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI) [17], Insomnia Symptom Questionnaire [18], Athens Insomnia Index [19], and ISI [20].”
Method
COVID-19-related social isolation and symptoms of depression and anxiety in young men in Poland: Does insomnia mediate the relationship?
Mojsa‐Kaja, J., Szklarczyk-Smolana, K., Niedzielska, E., Kurpińska, A., Suraj, J., & Walczak, M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285797 · Cited by 9
“Moreover, previous studies have indicated that Athens Insomnia Scale is useful in the assessment of the subjective symptoms of insomnia [56] during the COVID-19 pandemic; however, including objective measurements such as polysomnography and actigraphy in future studies may help to measure sleep deprivation more object…”
MethodInfluential
Excessive daytime sleepiness in depressed women
Calati, R., Gaspar-Barba, E., Cruz-Fuentes, C. S., Nenclares‐Portocarrero, A., Jiménez‐Genchi, A., Ronchi, D. D., & Serretti, A. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.11.021 · Cited by 9
“The Athens Insomnia Scale (AIS) (Soldatos et al., 2000) is a self-administered questionnaire composed of eight items.”
Method
Váltott műszakban dolgozó ápolók alvásminőségének vizsgálata a magyar nyelvre adaptált Bergen Shift Work Sleep Questionnaire alkalmazásával
Fusz, K., Tóth, Á. L., Fullér, N., Müller, Á., & Olah, A. (2015) · Orvosi Hetilap · doi:10.1556/650.2015.30311 · Cited by 10
Efficacy of sleep education program based on principles of cognitive behavioral therapy to alleviate workers’ distress
Yamamoto, M., Sasaki, N., Somemura, H., Nakamura, S., Kaneita, Y., Uchiyama, M., & Tanaka, K. (2015) · Sleep and Biological Rhythms · doi:10.1007/s41105-015-0045-3 · Cited by 9
Depression and insomnia are independently associated with satisfaction and enjoyment of life in medication-overuse headache patients
Pompili, M., Innamorati, M., Lamis, D. A., Serafini, G., Ricci, F., Migliorati, M., Bellini, S., Erbuto, D., Mazza, M., Nicola, M. D., et al. (2016) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217416680804 · Cited by 9
“Patients were administered the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q),(29) the Beck Depression Inventory – II (BDI),(30) and the Athens Insomnia Scale (AIS).(31) Table 1.”
Method
Acupuncture and moxibustion for primary insomnia: A systematic review and meta-analysis of randomized controlled trials
Huang, K., Liang, S., Grellet, A., & Zhang, J. (2017) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2017.04.007 · Cited by 9
Exploring the Profile of Incidental Memory in Patients with Amnestic Mild Cognitive Impairment and Mild Alzheimer’s Disease
Kontaxopoulou, D., Beratis, I., Fragkiadaki, S., Pavlou, D., Andronas, N., Yannis, G., Economou, A., Papanicolaou, A. C., & Papageorgiou, S. G. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-180328 · Cited by 9
“…symptoms: Neuropsychiatric Inventory [26], Frontal Behavioral Inventory [27], Geriatric Depression Scale [28]; 2) sleep quality: Epworth sleepiness scale [29], Athens Insomnia Inventory [30]; 3) motor disorders; and 4) functionality of everyday life: Functional Activities Questionnaire [31].”
Machine Learning Model for Predicting Insomnia Levels in Indian College Students
Seth, A., Babu, B. S., & Iyenger, S. S. (2019) · International Conference on Computation System and Information Technology for Sustainable Solutions (CSITSS) · doi:10.1109/csitss47250.2019.9031041 · Cited by 10
“[31].”
Increased incidence of metabolic syndrome among older survivors relocated to temporary housing after the 2011 Great East Japan earthquake & tsunami
Takahashi, S., Yonekura, Y., Tanno, K., Shimoda, H., Sakata, K., Ogawa, A., Kobayashi, S., & Kawachi, I. I. (2020) · Metabolism Open · doi:10.1016/j.metop.2020.100042 · Cited by 9
Affective temperaments moderate the effect of insomnia on depressive symptoms in adult community volunteers
Toyoshima, K., Inoue, T., Masuya, J., Fujimura, Y., Higashi, S., & Kusumi, I. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.138 · Cited by 9
Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double-blind randomized controlled exploratory and pragmatic trial
Gardoki-Souto, I., de la Torre, O. M., Hogg, B., Redolar-Ripoll, E., Valiente-Gómez, A., Martínez-Sadurní, L., Blanch, J. M., Lupo, W., Pérez, V., Raduà, J., et al. (2021) · Trials · doi:10.1186/s13063-021-05042-w · Cited by 9
“Athens Insomnia Scale (AIS) [83], Spanish validation [84].”
Method
Educabilidad y salud mental de universitarios salvadoreños durante la pandemia por Covid-19
Mena, F. J., Paz, V. D., Avilés, M., & Orantes, L. D. C. (2021) · Ciencia y Educación · doi:10.22206/cyed.2021.v5i3.pp19-38 · Cited by 11
Efficacy and Safety of Cordyceps militaris as an Adjuvant to Duloxetine in the Treatment of Insomnia in Patients With Depression: A 6-Week Double- Blind, Randomized, Placebo-Controlled Trial
Zhou, J., Chen, X., Xiao, L., Zhou, J., Feng, L., & Wang, G. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.754921 · Cited by 10
“A sum score is calculated (range: 0–24), with lower scores indicating fewer insomnia symptoms (29).”
Background
Sleep insufficiency and incident diabetes mellitus among indigenous and minority populations in Greece
Matziridis, A., Tsiptsios, D., Manolis, A., Ouranidis, A., Triantafyllis, A. S., Tsamakis, K., Serdari, A., Leontidou, E., Terzoudi, A., Dragioti, E., et al. (2021) · Sleep Science · doi:10.5935/1984-0063.20200081 · Cited by 9
“In order to assess daytime sleepiness, insomnia, sleep quality and risk of obstructive sleep apnea (OSA), the participants filled in the following standardized scales in Greek version, Epworth sleepiness scale (ESS) 20 , Athens insomnia scale (AIS) 21 , Pittsburgh sleep quality index (PSQI) 22 , and Berlin questionnai…”
Influential
Prevalence and variables associated with insomnia among COVID-19 survivors in Colombia.
Pedrozo‐Pupo, J. C., Caballero‐Domínguez, C. C., & Campo‐Arias, A. (2022) · PubMed Central · doi:10.23750/abm.v93i1.12132 · Cited by 9
“For example, in the general population, the prevalence of insomnia, quantified with AIS, was observed in 11% of 1,685 official employees in Japan (12), 27% in 1,325 women in menopause in Information on the prevalence and variables associated with insomnia in COVID-19 survivors is scarce.”
BackgroundInfluential
The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease
Japan Study Group of NAFLD (JSG-NAFLD), Taketani, H., Sumida, Y., Tanaka, S., Imajo, K., Yoneda, M., Hyogo, H., Ono, M., Fujii, H., Eguchi, Y., et al. (2013) · Journal of Gastroenterology · doi:10.1007/s00535-013-0871-5 · Cited by 9
“Table 1 Athens Insomnia Scale (AIS) [26]”
Method
The FIBRO System: a rapid strategy for assessment and management of fibromyalgia syndrome
Boomershine, C. S. (2010) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x10374437 · Cited by 9
“…scale for fatigue [Krupp et al. 1989], the Everyday Cognition Scale for fibrofog [Farias et al. 2008], the Athens Insomnia Scale for insomnia [Soldatos et al. 2000], the Physicians Health Questionnaire-9 for depression [Kroenke et al. 2001], the Generalized Anxiety Disorder-7 for anxiety…”
Background
Sleep Quality of Call Handlers Employed in International Call Centers in National Capital Region of Delhi, India
Raja, J., & Bhasin, S. (2016) · The International Journal of Occupational and Environmental Medicine · doi:10.15171/ijoem.2016.783 · Cited by 10
“Sleep quality of respondents was assessed by a validated 8-item Athens Insomnia Scale.(9) This scale has been constructed in accord with the ICD-10 criteria for insomnia.”
MethodInfluential
Improving Athlete Mental Training Engagement Using Smartphone Phone Technology
Rist, B., & Pearce, A. J. (2016) · International Journal of Social Science and Humanity · doi:10.18178/ijssh.2017.v7.809 · Cited by 9
Inactograms and objective sleep measures as means to capture subjective sleep problems in patients with a bipolar disorder
Lavín, P., Bourguignon, C., Crescenzi, O., Beaulieu, S., Storch, K.-F., & Mantere, O. (2020) · Bipolar Disorders · doi:10.1111/bdi.12903 · Cited by 10
The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery
Szabó, A., Tóth, K., Nagy, Á., Domokos, D., Czobor, N. R., Eke, C., Sándor, Á. D., Merkely, B. P., Susánszky, É., Gál, J., et al. (2021) · BMC Geriatrics · doi:10.1186/s12877-020-01994-x · Cited by 12
Potential of Activin B as a Clinical Biomarker in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Grāvelsiņa, S., Nora-Krūkle, Z., Vilmane, A., Svirskis, Š., Vecvagare, K., Krūmiņa, A., & Murovska, M. (2021) · Biomolecules · doi:10.3390/biom11081189 · Cited by 9
“We used the Athens Sleep Questionnaire [28], including problems in 6 or more of the following sleep-related questions: impaired sleep induction, awakening during the night, final awakening earlier than desired, insufficient total duration of sleep, impaired quality of sleep and impaired sense of well-being and/or phys…”
Alteraciones del sueño y calidad de vida en la epilepsia parcial refractaria: resultados del estudio SLEEP
Morales, I. G., Rein, A. G.-N., de Rosendo, J., & Falcón, A. T. (2014) · Revista de Neurología · doi:10.33588/rn.5804.2013213 · Cited by 9
“El 8% de los pacientes con epilepsia no refractaria y el 19% de los pacientes con epilepsia refractaria (p = 0,0004) presentaban somnolencia excesiva diurna (puntuación de la ESS > 12), mientras que el 17% de los pacientes con epilepsia no refractaria y el 38% de los pacientes con epilepsia refractaria (p < 0,0001) pr…”
BackgroundInfluential
Sleep quality changes in insomniacs and non-insomniacs after acute altitude exposure and its relationship with acute mountain sickness
Huang, L. J., Tang, X.-G., Zhang, J.-H., Gao, X., Li, Q., Li, J.-B., Yu, J., & Qin, J. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s67218 · Cited by 9
“Additionally, the participants’ subjective sleep habits were assessed using the Athens Insomnia Scale (AIS).(13) The demographic characteristics (eg, age, race, education, drinking and smoking habits) of the participants were recorded in the questionnaire.”
Method
Diagnostic Tools for Insomnia
Ong, J. C., & Suh, S. A. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-378610-4.00196-0 · Cited by 9
Mindfulness as a Symptom Management Strategy for Fibromyalgia: An Integrative Review.
Gordon, S., Brown, R., Hogan, M., & Menzies, V. (2023) · Journal of Holistic Nursing · doi:10.1177/08980101221123833 · Cited by 8
“The four outcome measures used to measure sleep were the Athens Insomnia Scale (AIS) (Soldatos et al., 2000) for subjective insomnia, the Pittsburgh Sleep Quality Index (PSQI) (Buysse et al., 1989) for sleep quality, the Epworth Sleepiness Scale (ESS) (Johns, 1991) for sleepiness, and the Sleep Impairment Index (SII)…”
Method
Phenotypic Profiling of People With Subjective Tinnitus and Without a Clinical Hearing Loss
Tang, D., Lu, X., Huang, R., Yu, H., & Li, W. (2022) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2022.804745 · Cited by 8

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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