0387 Sleep-SMART for Veterans with Mild Cognitive Impairment (MCI) and Insomnia: A Pilot Study

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Abstract Introduction Mild cognitive impairment (MCI) is an important public health concern for aging Veterans as it is a known risk factor for progression to dementia. Insomnia is common in MCI occurring in up to 60% of patients. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended treatment for insomnia, however, cognitive impairments experienced by individuals with MCI may limit the ability of some individuals to adequately understand and actively participate in CBT-I. In this study a modified CBT-I treatment Sleep-SMART (Sleep Symptom Management and Rehabilitation Therapy) was developed and pilot tested with Veteran input. Sleep-SMART incorporates supportive cognitive strategies into a CBT-I protocol to enhance CBT-I learning and adherence. Methods 14 Veterans completed the 6-week Sleep-SMART intervention. Each participant was assessed on the Insomnia Severity Index (ISI) and the Pittsburgh Quality Sleep Index (PSQI) at pre- and post-treatment (Weeks 0 and 6 respectively). Veterans also completed weekly sleep diaries for the duration of the 6-weeks of treatment. Independent t-tests were performed comparing pre and post-treatment scores for the ISI, PSQI, and sleep diary variables (sleep efficiency [SE], total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], and early morning awakening [EMA]). Treatment acceptability was examined using the average rating on the Acceptability of Intervention Measure (AIM; 1–5-point Likert type scale, with higher scores indicating greater acceptability). Results Participants (11M/3F, age=71.8+/-6.9yrs) showed significant symptom improvement on both ISI (pre=18.25/post=10.83,p<.001) and PSQI (pre=11/post=8.73,p=.034) total scores. This improvement was further illustrated in the sleep diary measures which showed significant improvement across all metrics: SE (pre=70%/post=89%,p<.001), TST (pre=5.40hrs/post=6.49hrs,p=.007), WASO (pre=50.53mins/post=20.73mins,p<.001), and EMA (pre=61.29mins/post=15.16mins,p=.003). Importantly, the Sleep-SMART treatment protocol was viewed as acceptable to Veterans (AIM; M=4.46,SD= 0.62). Conclusion The Sleep-SMART intervention was viewed as acceptable and produced significant improvements in insomnia symptoms. These findings suggest that Sleep-SMART has the potential to be an effective modified form of CBT-I treatment that is uniquely tailored to aging Veterans with cognitive challenges. Future randomized controlled trials are warranted to investigate the efficacy of Sleep-SMART more broadly. Support (if any) This research supported by SPiRE Award 1 I21 RX003721-01A1 (D3721-P) from Department of Veterans Affairs Rehabilitation Research and Development Service.

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