Feasibility and Preliminary Efficacy of an Internet-Delivered Intervention for Insomnia in Individuals with Mild Cognitive Impairment

Article type: Research Article

Authors: Mattos, Meghan K.^{a; *} | Manning, Carol A.^{a; b} | Quigg, Mark^b | Davis, Eric M.^b | Barnes, Laura^c | Sollinger, Ann^d | Eckstein, Michelle^e | Ritterband, Lee M.^b

Affiliations: [a] University of Virginia, School of Nursing, Charlottesville, VA, USA | [b] University of Virginia, School of Medicine, Charlottesville, VA, USA | [c] University of Virginia, School of Engineering and Applied Sciences, Charlottesville, VA, USA | [d] Virginia Tech Carilion School of Medicine, Roanoke, VA, USA | [e] MedStar Georgetown University Hospital, Washington, DC, USA

Correspondence: [*] Correspondence to: Meghan K. Mattos, Assistant Professor, Acute and Specialty Care, University of Virginia School of Nursing, McLeod Hall-Room 5012, PO BOX 800782, Charlottesville, VA, USA. Tel.: 434-243-3936; Fax: 434-924-2787; E-mail: ms2bv@virginia.edu.

Abstract: Background:Approximately 50% of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. Objective:To determine feasibility, acceptability, and preliminary efficacy of Sleep Health Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi OASIS), an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program in older adults with mild cognitive impairment (MCI). Methods:Older adults with MCI and insomnia were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm pilot study. Participants completed the six cores of SHUTi OASIS, over nine weeks with two-week baseline and post-assessments using self-reported sleep diaries. Feasibility and acceptability were informed by usage statistics and qualitative interviews; preliminary efficacy was informed by patient-generated sleep data. Results:Twelve participants enrolled and, on average, were 75.8 years of age. Ten participants completed the study and logged in most days. Most participants reported a positive overall experience, and interviews revealed successful and independent program management and completion. There were significant changes on all baseline to post-assessment sleep measures, including clinically meaningful improvements on the Insomnia Severity Index (13.5 to 8.3, p < 0.01), sleep efficiency, wake after sleep onset, and sleep onset latency (ps < 0.02). There was no statistically significant change in cognitive measures (p > 0.05). Conclusion:This study supports that older adults with cognitive impairment can independently complete CBT-I via the Internet and achieve clinical sleep improvements.

Keywords: Aged, behavioral intervention, cognitive dysfunction, insomnia, Internet, mild cognitive impairment, research

DOI: 10.3233/JAD-210657

Journal: Journal of Alzheimer's Disease, vol. 84, no. 4, pp. 1539-1550, 2021