Abstract Introduction Insomnia affects up to one-third of older adults undergoing knee/hip replacement surgery and yet it remains undertreated in perioperative care. Cognitive Behavioral Therapy for Insomnia (CBT-I) has rarely been attempted in this population due to unpredictable timing and resource-limitations before and/or after surgery. This pilot study examined whether an abbreviated CBT-I protocol improves insomnia symptoms and surgical outcomes in older patients. Methods SLEEP-BOOST is an NIH-funded single-site randomized pilot trial (R03AG087439; NCT06052397) at MGH. Since Jan 2025, 18 (target: 50 by 2026) knee/hip replacement patients (age≥65) with insomnia ( ISI ≥10) completed our study up until 1 month post-surgery having been randomized 1:1 to a CBT-I or Sleep-Hygiene Education group (SHE; matched patient contact control), three weeks before surgery with a booster session 2-3 weeks after. ISI, general sleep quality (PSQI), pain, and cognitive performance (Montreal Cognitive Assessment; MoCA) were assessed at baseline and 1-month. Paired t-tests evaluated within-group ISI changes (ΔISI 95% CI, Cohen’s d d), and linear mixed-effects models tested whether ISI influenced postoperative outcomes, adjusting for age and sex. Results The CBT-I group, showed progressive and large improvement in insomnia severity through to 1-month after surgery (ΔISI = -4.3; p = 0.01; d = 1.2); the SHE group showed preoperative improvements that were not fully sustained (ΔISI = -0.13; p = 0.93; d = 0.03). Between-group comparison: CBT-I group vs. SHE (ΔISI: −4.25 vs. −0.13; p = 0.04). Within-group comparisons showed that CBT-I was associated with improved global sleep quality (ΔPSQI (Baseline vs. 1-month) = -1.29; p = 0.004; d = 1.7) and cognitive performance (ΔMoCA = 1.7; p = 0.04; d = 0.8), whereas the control group showed no postoperative changes for sleep quality and cognitive performance (ps .05). The LME models showed no change in pain over time in either group. Conclusion Our results showed that the abbreviated perioperative CBT-I intervention was feasible and associated with reduced insomnia symptoms, improving sleep quality, and postoperative cognitive recovery in older surgical patients. Full trial results with 3-month follow-up will strengthen our preliminary findings and determine whether CBT-I provides more durable postoperative benefits than control in older surgical patients. Support (if any)
Charles et al. (Fri,) studied this question.