Gender Identity Disparities in Early Adolescent Sleep: Findings from the Adolescent Brain Cognitive Development Study

CLINICAL QUESTION

Are transgender early adolescents at increased risk of sleep disturbance and shorter sleep duration compared with cisgender peers?

BOTTOM LINE

Transgender early adolescents demonstrated significantly higher rates of caregiver-reported sleep disturbance, insomnia symptoms, excessive daytime sleepiness, and short sleep duration compared with cisgender peers. The findings highlight important sleep disparities in transgender youth and support targeted screening and intervention efforts.

BACKGROUND: Sleep plays a critical role in adolescent physical health, cognitive function, and emotional well-being. Poor sleep has been associated with obesity, depression, anxiety, academic difficulties, and risky behaviors. Although sleep disparities have been reported among sexual minority youth, limited data exist regarding sleep outcomes in transgender adolescents.

STUDY DESIGN: Cross-sectional analysis of Year 3 data (2019-2021) from the Adolescent Brain Cognitive Development (ABCD) Study. Caregiver-reported sleep outcomes were assessed using the validated Sleep Disturbance Scale for Children (SDSC), and associations between transgender identity and sleep measures were evaluated using adjusted regression models.

SETTING: National multicenter U.S. cohort study involving 21 sites participating in the ABCD Study

SYNOPSIS: The analysis included 10,277 adolescents aged 12-13 years, of whom approximately 1% identified as transgender. Caregivers of transgender adolescents were significantly more likely to report overall sleep disturbance compared with caregivers of cisgender youth (adjusted RR 2.15; 95% CI, 1.52–3.04; p<0.001). Similar findings were observed among adolescents who responded “maybe” to the transgender identity question.

Subscale analyses demonstrated that transgender adolescents had significantly higher rates of disorders related to initiating and maintaining sleep as well as excessive daytime somnolence. Caregivers also reported markedly shorter sleep duration among transgender youth across nearly all sleep categories. Compared with the reference range of nine to 11 hours of sleep, transgender adolescents were significantly more likely to sleep eight to nine hours, seven to eight hours, five to seven hours, and fewer than five hours nightly. Particularly notable was the increased likelihood of sleeping fewer than five hours per night (adjusted RR 38.97; 95% CI, 2.78–545.73; p=0.007).

The authors suggest that minority stress, gender dysphoria, psychosocial distress, and social stigma may contribute to these disparities. They additionally note that adolescents questioning their gender identity may experience similar stressors contributing to sleep disturbance. Limitations include reliance on caregiver-reported sleep data, small numbers of transgender participants, lack of nuanced gender identity categories, and the cross-sectional design precluding causal inference. Nevertheless, the findings represent one of the first large national analyses demonstrating significant sleep disparities among transgender early adolescents.

CITATION: Ricklefs C, et al. Gender identity disparities in early adolescent sleep: findings from the Adolescent Brain Cognitive Development Study. LGBT Health. 2025;12:231-236. doi:10.1089/lgbt.2023.0431.