Effectiveness of behavioural sleep programs for middle-aged adults on cognition and sleep and associated behaviour change techniques: a systematic review and meta-analysis

Poor sleep duration and quality in middle age is associated with higher dementia risk in late adulthood. The aim of this review was to (i) identify the effectiveness of behaviour change techniques (BCT)-based therapies in improving both sleep and cognition simultaneously; and (ii) determine the specific aspects of BCTs that were most effective for improving sleep and cognition in mid-life adults. Electronic databases (MEDLINE, EMBASE, PsycINFO) were searched. Inclusion criteria were randomised controlled trials (RCTs), adults aged between 45 and 64 years, behavioural/cognitive interventions targeting sleep quality and duration, and measured outcome on cognitive function. A narrative synthesis and risk of bias (Cochrane Risk of Bias) and study quality (GRADE) was conducted, with BCTs mapped to the BCT Taxonomy V1. 6013 records were reviewed and 6 RCTs (N = 969 participants) reporting both online and face to face behavioural interventions for sleep were found. Interventions were mostly focused on meditation (e.g., yoga training (2/6, 33.3%) or meditation exercises (2/6, 33.3%)). Overall, 28 out of a possible 93 BCTs (30.1%) were identified as targeting change in sleep behaviour to improve cognition (range: 7-22, mean: 14.7). BCT categories commonly used were goal setting, shaping knowledge, natural consequences, comparison of behaviour, repetition/substitution, comparison of outcomes, regulation and antecedents. These BCTs were also linked to positive outcomes for cognition and sleep quality. Identification of BCTs may provide a helpful understanding on the content used in interventional trials and be used to inform more effective structured lifestyle intervention strategies. There is unexplored potential for using currently untested BCTs in future interventions targeting improved sleep and cognition for middle-aged adults.