Inadequate sleep associated with increased odds of subjective cognitive decline among transgender and gender nonbinary adults in the U.S., 2016‐2018

Abstract

AbstractBackgroundInadequate sleep (<7 hours/night) and subjective cognitive decline (SCD), a self‐reported experience of worsening memory or thinking, are independently associated with an increased risk for Alzheimer’s disease and related dementias (ADRD) and cognitive impairment. Transgender and nonbinary (TNB) adults report significantly poorer sleep quality and are more likely to report SCD compared to cisgender adults. However, little is known about ADRD risk or how inadequate sleep is associated with SCD among TNB adults.Method2016‐2018 Behavioral Risk Factor Surveillance System data, representing 14 U.S. states that assessed sleep duration, SCD, and TNB status from adults ages 45+, were analyzed to examine differences in inadequate sleep prevalence and SCD among TNB adults (n = 394) and cisgender adults (n = 120,688). Odds ratios (OR) along with 95% confidence intervals (CI) were calculated to investigate group differences in inadequate sleep prevalence. A separate analysis compared the prevalence of SCD among TNB and cisgender adults with inadequate sleep.ResultInadequate sleep was highest among TNB adults (37.9%) compared to cisgender adults (31.34%). TNB adults were 34% more likely to report inadequate sleep compared to cisgender adults (95% CI: 1.1‐1.7, p = 0.0180). Inadequate sleep significantly increases the likelihood of SCD by 1.3 times (95% CL: 1.2, 1.3) compared to sleeping ≥7 hours/night. Among those with inadequate sleep, TNB adults were 2.3 times more likely to report SCD compared to cisgender adults (95% CI: 1.2‐3.6, p = <0.0001).ConclusionInadequate sleep and its relationship with SCD is not uniformly experienced among TNB and cisgender adults. It is important to explore and address modifiable risk factors affecting sleep duration among TNB adults. Given the literature linking sleep duration, SCD, and ADRD risk, these data highlight the need for additional research focused on better understanding TNB cognitive health. The use of objective measures to assess sleep and cognition will provide more precision, which is needed to develop tailored interventions for TNB adults.