0430 Perioperative Sleep Optimization: Effects on Neurocognitive Recovery and Surgical Outcomes in Older Adults (SLEEP-BOOST trial)

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)