A Pilot Study of Digital Sleep Optimization for Brain Health Outcomes in Older Surgical Patients (SLEEP-BOOST)
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PROJECT SUMMARY/ABSTRACT Sleep disorders, including insomnia, are likely present in up to a third of older patients before surgery, but most remain untreated. Increasing evidence suggests insomnia-related sleep disturbances greatly impede recovery, including vulnerability to neurocognitive disorders (NCD), the most common surgical complication in older adults. Once diagnosed, up to half can progress to Alzheimer’s disease (AD) and related dementias (ADRD) within five years. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been the first-line therapy to improve sleep for over a decade. It can reduce anxiety, improve pain tolerance and enhance physical and cognitive function. Yet, no form of it is currently an option before surgery. This proposal involves the Sleep Optimization for Brain Health Outcomes in Older Surgical Patients (SLEEP-BOOST) trial to establish the feasibility and explore the efficacy of an abbreviated, digital CBT-I intervention (dCBT-I) in older surgery patients with insomnia symptoms. Our central hypothesis is that decreasing insomnia-related sleep disruption is feasible before surgery, improves sleep, and promotes cognitive resilience. To test this, we have developed a pragmatic dCBT-I protocol found to be effective for sleep, anxiety, and depression at 2 weeks as part of an app-based program synchronized to an actigraphy watch and self- administered with scheduled guidance by trained non-specialists supervised by a sleep physician. We prioritize key components that can be implemented quickly: sleep hygiene education (SHE), stimulus control, sleep consolidation, cognitive restructuring, and relaxation techniques. We will randomize 50 older adults (>65y) undergoing elective orthopedic joint surgery who have at least moderate insomnia by the Insomnia Severity Index 1:1 to dCBT-I (4 hybrid sessions 30-60 mins) or control (SHE only plus usual care). This surgical population is ideal for many reasons: 1) insomnia symptoms are highly prevalent, 2) pain, depression, and anxiety are comorbid with insomnia, 3) sufficient time before surgery (~3 weeks), and 4) low surgical/patient variability has led to an established pipeline of NIH-funded NCD studies from the PI’s department. Guided by strong preliminary data, we propose the following Specific Aims: 1) Establish the feasibility of the dCBT-I protocol in older surgical patients with insomnia symptoms, and 2) Examine the effects of dCBT-I on sleep and cognitive trajectory after surgery. Significance: This proposal addresses a key gap in improving sleep in older persons undergoing major surgery. It is a meaningful way to develop a pilot sleep intervention that is the gold standard for insomnia outside the perioperative period. Innovation: Few studies have leveraged this unique, multidisciplinary approach to test an existing intervention now tailored to surgical patients. Impact: Successful completion will accrue early-stage clinical pilot data for the feasibility of sleep improvement in a highly burdened surgical cohort.
