Gender identity and transition: relationships with sleep disorders in US youth

Ronald Gavidia; Daniel G Whitney; Shelley Hershner; Ellen M Selkie; Riva Tauman; Galit Levi Dunietz

doi:10.5664/jcsm.10158

Gender identity and transition: relationships with sleep disorders in US youth

J Clin Sleep Med. 2022 Nov 1;18(11):2553-2559. doi: 10.5664/jcsm.10158.

Authors

Ronald Gavidia¹, Daniel G Whitney^{2

3}, Shelley Hershner¹, Ellen M Selkie⁴, Riva Tauman⁵, Galit Levi Dunietz¹

Affiliations

¹ Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan.
² Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor Michigan.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
⁴ Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin.
⁵ Sleep Disorders Center, Tel Aviv Souraski Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

Study objectives: Transgender or gender-nonconforming (TGNC) identity is associated with higher burden of sleep disorders relative to cisgender identity. However, the role of gender-affirming therapy (GAT) in sleep disorders is poorly understood. This study examined relationships between TGNC identity, transition, and sleep disorders among TGNC and cisgender youth.

Methods: This retrospective cross-sectional study utilized a large US-based administrative claims database (deidentified Optum Clinformatics Data Mart Database) to identify youth aged 12-25 years who obtained a diagnosis of TGNC identity and those who pursued GAT. Descriptive statistics estimated distributions of demographic and health characteristics by gender identity. Unadjusted and age-adjusted logistic regression models were used to examine associations between TGNC identity, GAT, and sleep disorders.

Results: This study included 1,216,044 youth, of which 2,603 (0.2%) were identified as TGNC. Among the 1,387 TGNC who pursued GAT, 868 and 519 were identified as transmasculine and transfeminine, respectively. Adjusted analysis showed increased odds of insomnia (odds ratio = 5.4, 95% confidence interval 4.7, 6.2), sleep apnea (odds ratio = 3.0, 95% confidence interval 2.3, 4.0), and other sleep disorders (odds ratio = 3.1, 95% confidence interval 2.5, 3.9) in TGNC relative to cisgender youth. Decreased odds of any sleep disorder were observed in the TGNC youth on GAT (odds ratio = 0.5, 95% confidence interval 0.4, 0.7) relative to those not on GAT.

Conclusions: This study demonstrated a high burden of sleep disorders in TGNC youth in comparison to cisgender. However, GAT may confer a protective effect on sleep disorders among TGNC youth. Longitudinal assessments of sleep disorders prior to and post-GAT are needed to uncover their temporal relationships.

Citation: Gavidia R, Whitney DG, Hershner S, Selkie EM, Tauman R, Dunietz GL. Gender identity and transition: relationships with sleep disorders in US youth. J Clin Sleep Med. 2022;18(11):2553-2559.

Keywords: gender-affirming therapy; sleep disorders; transgender persons.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Cross-Sectional Studies
Female
Gender Identity
Humans
Male
Retrospective Studies
Sleep Wake Disorders* / epidemiology
Transgender Persons*

Abstract

Publication types

MeSH terms

Grants and funding