0437 Perioperative CBT-I for Older Surgical Patients: Feasibility and Engagement Results from the SLEEP-BOOST Trial

Abstract Introduction Insomnia affects up to one-third of older adults undergoing elective joint replacement and is linked to poorer postoperative recovery, yet it remains largely unaddressed in perioperative care. Sleep interventions, including Cognitive Behavioral Therapy for Insomnia (CBT-I), have rarely been attempted in this population due to unpredictable timing and resource-limitations before and/or after surgery. We tested the feasibility of a condensed CBT-I intervention in older surgical patients with insomnia. Methods SLEEP-BOOST is an NIH-funded single-site randomized pilot trial (R03AG087439; NCT06052397) at MGH. Since Jan 2025, 27 (target: 50 by end of 2026) knee/hip replacement patients (age≥65) with Insomnia Severity Index≥10 have been randomized 1:1 to the CBT-I group (three virtual sessions plus CBT-I Coach app) or sleep-hygiene education with matched contact control over Weeks 1-3 pre-op and post-op. Feasibility was assessed by the completion of daily sleep diary days (pre-/post-op) and an Adherence Form developed by the Veterans Affairs CBT-I Training Program (Week 2 & 3). Treatment-arm adherence items included practicing CBT-I components and app use; control-arm focused on sleep-hygiene tips. Adherence scores were calculated as the sum of item ratings (1-5 Likert scale). Participants were also asked to wear an actigraphy watch throughout the study (≥7 days pre-/post-op). Participants who dropped out were excluded (treatment n=9; control n=12). Results Daily sleep-diary completion in the treatment-arm was 97%±15.2 of assigned diaries, and the control-arm achieved 93%±14.9. Actigraphy data (≥7 days) were obtained from 95% participants pre-op and 83% post-op. All participants in the treatment-arm (100%) reported engaging with CBT-I components and 80% reported app use throughout the intervention. Participants in the treatment-arm spent 0.94 hours during Week 2, and 1.20 hours during Week 3 on the CBT-I Coach app and intervention practices. Adherence questionnaire scores were initially lower in the treatment arm at Week 2 (16.8±5.04 vs. 24.7±6.04; p=0.004) but improved significantly to be similar by Week 3 (20.0±3.91 vs. 24.4±6.14; p>0.05). Conclusion Our findings suggest that perioperative CBT-I is feasible in older adults preparing for joint replacement, with excellent adherence to both daily diaries and intervention components. Whether this level of engagement improves insomnia symptoms and postoperative recovery remains to be seen. Support (if any)