The Impact of BBTI on Cognition and Sleep Health in Older Adults with HIV - Abstract Approximately 70% of people with HIV (PWH) will be age 50 or older by 2030. Poor sleep and neurocognitive impairment are commonly reported in PWH and older adults. HIV and age-related changes in sleep patterns are associated with neurocognitive impairments. This can be detrimental for people aging with HIV given nearly half the population report mild to moderate forms HIV-Associated Neurocognitive Disorder (HAND). The impact of poor sleep on cognition in older adults with HIV may increase the risk for neurodegenerative disorders such as Alzheimer’s Disease (AD). Brief Behavioral Treatment for Insomnia (BBTI) focuses on sleep restriction and stimulus control and has shown efficacy in improving insomnia in several populations including middle-aged adults with HIV. Similarly, Brief Mindfulness Therapy (BMT) includes meditation and breathing exercises and has demonstrated improvement in insomnia in PWH. This study will examine BBTI versus BMT efficacy on sleep and neurocognitive outcomes in older PWH. The overarching hypothesis is that BBTI (compared to BMT) will yield greater improvement in sleep outcomes, and sleep outcomes will correlate with neurocognitive outcomes in older PWH. This study, a randomized single blind design with experimenter blinding, has three aims. Aim 1: Examine the effects of BBTI versus BMT on subjective and objective sleep outcomes in older PWH up to 1-year post-treatment. We will randomly assign 214 PWH (age 50+) with insomnia to receive either BBTI or BMT (control) via telephone for four weeks (once a week for 30 minutes). Subjective insomnia assessments and 7-day actigraphy will be conducted at baseline, post BBTI/BMT, and 1-year post-treatment. Aim 2: Examine the effects of BBTI versus BMT on neurocognitive outcomes in older PWH and insomnia. The Delis-Kaplan Executive Function System will assess executive function, the Repeatable Battery for the Assessment of Neuropsychological Status will assess five neurocognitive domains (immediate memory, visuospatial, language, attention, and delayed memory), and the Patient’s Assessment of Own Functioning will measure self-report of cognition at baseline, post BBTI/BMT, and 1-year post-treatment. Aim 3: Explore the relationship between AD biomarkers and subjective and objectives sleep and neurocognitive outcomes in PWH receiving BBTI versus BMT at three timepoints (baseline, post, and 1-year post-treatment). Study findings will expand existing research on BBTI as an effective nonpharmacological sleep intervention for older PWH. Furthermore, this study lays the foundation for programmatic research that examines BBTI effects on cognition and AD risk in adults aging with HIV.
