# A Pilot Study of Digital Sleep Optimization for Brain Health Outcomes in Older Surgical Patients (SLEEP-BOOST)

> **NIH NIH R03** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $134,000

## Abstract

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 improve...

## Key facts

- **NIH application ID:** 10890421
- **Project number:** 1R03AG087439-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Lei Gao
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $134,000
- **Award type:** 1
- **Project period:** 2024-08-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10890421

## Citation

> US National Institutes of Health, RePORTER application 10890421, A Pilot Study of Digital Sleep Optimization for Brain Health Outcomes in Older Surgical Patients (SLEEP-BOOST) (1R03AG087439-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10890421. Licensed CC0.

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