TL;DR: SLEEP-BOOST is a pilot trial examining whether Cognitive Behavioural Therapy for Insomnia (CBT-I) delivered before elective surgery can improve sleep and reduce postoperative cognitive complications in older adults. This is a protocol paper, not results data, so no efficacy conclusions are possible yet. (feasibility/pilot design).
Postoperative neurocognitive complications represent a genuine clinical problem. After surgery, approximately one-third of older adults experience delirium (acute confusion), and some develop longer-term cognitive decline. These complications increase hospital stays, healthcare costs, and mortality risk. Yet perioperative prevention strategies remain sparse.
The SLEEP-BOOST study targets a specific modifiable risk factor: insomnia and circadian disruption before surgery. The researchers note that up to one-third of older adults undergoing elective surgery report insomnia symptoms. The logic is straightforward: if insomnia contributes to postoperative neurocognitive risk, addressing it preoperatively might reduce that risk. The intervention under study is CBT-I, the first-line, evidence-based treatment for insomnia. However, CBT-I has never been systematically evaluated as a perioperative brain-health strategy.
This is a feasibility-focused pilot study, not a definitive efficacy trial. The researchers will enroll 50 adults aged 65 or older undergoing elective orthopedic surgery who meet criteria for insomnia (Insomnia Severity Index score of 10 or higher). Half will receive a condensed CBT-I intervention; the other half will receive matched patient contact with sleep hygiene education (the control). The key question is not whether CBT-I cures delirium, but whether it can be delivered and accepted in the perioperative window.
Primary outcomes focus on feasibility: adherence rates, protocol engagement, and acceptability feedback. Secondary outcomes are explicitly labeled exploratory and include insomnia severity, sleep quality, objective sleep measures from actigraphy, cognitive trajectories, postoperative pain, mood, functional status, and the incidence of postoperative neurocognitive disorders. All participants will complete three weeks of preoperative sleep tracking via actigraphy and daily diaries, with follow-up at two weeks, one month, and three months post-surgery.
The timing matters. Insomnia in older adults is both common and often undertreated in surgical settings. Poor sleep before surgery correlates with worse outcomes across multiple dimensions: inflammation, pain perception, immune function, and cognitive reserve. Yet most preoperative evaluations focus on medical comorbidities and medication review, not sleep quality or behavioral interventions.
CBT-I is not a supplement or quick fix. It is a structured behavioral intervention targeting the thoughts, habits, and environmental factors that maintain insomnia. The "condensed" version here will likely be abbreviated to fit the preoperative timeline, raising a real question: does a truncated intervention retain efficacy? That's precisely what a pilot study should test.
The control group receives sleep hygiene education and matched clinician contact. This is a reasonable design choice. Sleep hygiene alone (consistent bedtime, dark room, avoiding caffeine late in the day) is less effective than CBT-I for chronic insomnia, but it ensures the control group is not ignored. The matched contact time controls for non-specific therapeutic effects.
This is an announcement of a trial design, not a results paper. No participant outcomes are reported yet. The study is registered (NCT06375265) and has received ethics approval from Massachusetts General Hospital's Institutional Review Board.
If you are an older adult facing elective orthopedic surgery with undiagnosed or untreated insomnia, the findings will matter when they arrive. Presently, if you report sleep problems to your surgical team, you may be offered sleeping pills (which carry their own perioperative risks) or told to "get more rest"—both unhelpful. CBT-I, if proven feasible to deliver preoperatively, could become a standard recommendation. It carries no pharmacological risk and addresses root causes rather than symptoms alone.
If you have chronic insomnia, CBT-I is already the evidence-based first-line approach regardless of surgical status. Common components include sleep restriction (limiting time in bed to actual sleep duration), stimulus control (bed reserved for sleep only), cognitive restructuring (challenging catastrophic sleep thoughts), and sleep schedule standardization. Some people combine behavioral work with sleep hygiene habits like maintaining cool room temperature, limiting caffeine, and digital wind-down.
Practically, this study will inform whether surgical teams should screen for insomnia preoperatively and refer patients for behavioral sleep treatment as a cognitive risk mitigation strategy. That would represent a shift from reactive (managing delirium after it occurs) to preventive care.
| Detail | Finding |
|---|---|
| Study type | Randomized controlled trial (pilot/feasibility phase) |
| Sample size | 50 older adults (target; final enrolled not yet reported) |
| Population | Adults aged 65+ undergoing elective orthopedic surgery with insomnia symptoms (ISI score ≥10) |
| Intervention | Condensed Cognitive Behavioural Therapy for Insomnia (CBT-I), delivered preoperatively |
| Control | Patient contact-matched Sleep Hygiene Education |
| Primary outcome | Feasibility (adherence, engagement, acceptability) |
| Secondary outcomes | Insomnia severity, sleep quality, actigraphy-derived sleep metrics, cognitive trajectories, postoperative pain, mood, functional status, incidence of postoperative neurocognitive disorders |
| Follow-up duration | 3 weeks preoperatively; post-operative assessments at 2 weeks, 1 month, 3 months |
| Site | Massachusetts General Hospital |
SLEEP-BOOST Protocol: Perioperative sleep optimisation and brain health in older adults. BMJ Open. 2024. PubMed ID: 42209013.
https://pubmed.ncbi.nlm.nih.gov/42209013
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| Status |
| Protocol approved; enrollment likely ongoing |
| Registration | NCT06375265 |
| Ethics approval | Massachusetts General Hospital IRB (Protocol #2024P000780) |
| Published | BMJ Open (2024) |