QOL-30. Mind over Mattress: Impact of Cognitive Behavioral Therapy for Insomnia on Objective and Subjective Sleep in Patients with Primary Brain Tumors

Abstract BACKGROUND Over 20% of patients with primary brain tumors (PBT) report clinically significant insomnia, yet these symptoms are often undertreated. Our team conducted the first trial of Cognitive Behavioral Therapy for Insomnia (CBT-I)—the recommended, first-line treatment—in patients with PBT. Primary findings suggest this intervention was safe, feasible, and acceptable. Moreover, patients demonstrated improvements in self-reported insomnia severity, fatigue, and mood. The aim of this secondary analysis was to assess changes in subjectively- and objectively-derived sleep metrics using data from patients’ sleep diaries and wrist-worn actigraphy. METHODS Patients with PBT and insomnia (N=44) enrolled in a single-arm pilot trial of CBT-I and completed one-week subjective (Consensus Sleep Diary) and objective (wrist-worn actigraphy; Actigraph GT9X) sleep assessments at baseline (T0) and post-intervention (T1). Participants underwent six weekly group CBT-I telehealth sessions. Subjectively- and objectively-derived sleep metrics include total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), number of awakenings (NOA), and perceived sleep quality (PSQ). We evaluated the accelerometer data using the GGIR package and conducted paired-sample t-tests to evaluate change in sleep metrics from T0 to T1. RESULTS Subjectively, data from participants’ sleep diaries revealed improvements in WASO (MΔ=-27.08, p<.001), SOL (MΔ=-27.04, p<.001), SE (MΔ=0.08, p<.001), NOA (MΔ=-5.42, p<.001), and PSQ (MΔ=0.60, p<.001). Both TIB (MΔ=-78.10, p<.001) and TST (MΔ=-36.64, p<.01) significantly decreased. Objectively, data from participants’ wrist-worn actigraphy revealed significant decreases in NOA (MΔ=-2.63, p<.001), SOL (MΔ=-19.46, p=.04), TIB (MΔ=-1.03, p<.001), and TST (MΔ=-0.90, p<.001). The accelerometer data did not reveal significant changes in WASO or SE (ps>.05). CONCLUSION CBT-I may lead to meaningful improvements in both subjective and objective sleep among patients with PBT. Larger, controlled trials are currently underway to confirm these preliminary findings and to further investigate discrepancies between subjective and objective sleep measures.