Adults with and without mild cognitive impairment show similar treatment adherence and sleep improvement after insomnia therapy

Abstract Introduction Non-pharmacological Insomnia Therapies are robustly effective in improving sleep in cognitively intact (CI) older adults. However, it remains unknown whether older adults with mild cognitive impairment (MCI) can engage in insomnia therapy to experience similar sleep improvements. Methods We leveraged an existing dataset derived from a randomized clinical trial (NCT02117388) in older adults with and without MCI to examine differences in treatment adherence and sleep improvements after completing six sessions of insomnia therapy. Healthy older adults with insomnia (n=127, Mage= 69.18, 34.4% male, MCI: n=38 determined by Montreal Cognitive Assessment score< 26) completed a one-week sleep diary at pre-treatment (BL), post-treatment (ET), and six-months post-treatment (6M). Wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) were calculated from sleep diaries. Treatment consisted of either the behavioral, cognitive, or combined components of Cognitive Behavioral Therapy for Insomnia (CBT-I). Participants rated their treatment adherence at the final treatment session. Linear mixed effects models were used to determine the effect of MCI status, time, and an MCI status-by-time interaction on each sleep outcome while covarying for age and sex. A Benjamini-Hochberg correction was applied to correct for multiple comparisons. Linear regression models controlling for age and sex were used to test group differences in treatment adherence scores. Results Both groups showed significant improvements in all sleep measures from BL to ET and sustained these improvements at 6M (padj’s< 0.016). There were no significant MCI status-by-time interactions for any sleep measure (padj’s > 0.29), suggesting individuals with and without MCI similarly improved their sleep. Further, there were no differences in treatment adherence scores between the CI and MCI groups (b=0.131, p=0.432), suggesting the MCI group engaged in therapy similarly to the CI group. Conclusion These preliminary findings suggest older adults with MCI may be capable of engaging in insomnia therapy to improve their sleep to the same degree as CI older adults. These findings also highlight the need of future research investigating the efficacy of non-pharmacological insomnia therapy on sleep and cognitive outcomes in older adults with MCI. Support (if any) NIMHR01MH101468-01; Mental Illness Research, Education, and Clinical Center (MIRECC) at VAPAHCS