LAUSR

The inclusion of sexual orientation and gender identity measurements in national epidemiological surveys allows for the assessment of sleep disparities among sexual and gender minorities. Our objective is to establish the association of sexual orientation and gender identity with sleep duration. We used 2020 Behavioral Risk Factor Surveillance System data from 33 states who included the sexual orientation and gender identity (SOGI) optional module in their questionnaires. The outcome variable is sleep duration (≤4 hours, 5, 6, 7, 8, 9, and ≥10 hours). Main predictors are sexual orientation (heterosexual, gay/lesbian, bisexual, and other) and gender identity (cisgender, trans woman, trans man, and trans gender non-conforming). We estimated multinomial logistic regression models due to the categorical nature of our outcome variable using Stata 17. We estimated models using sexual orientation alone as main predictor, gender identity alone, and then a combined model with both SOGI measures, and adjusted for sociodemographic characteristics and physical and mental health. Of the complete sample, 92% reported being heterosexual, 2% gay/lesbian, 3% bisexual, and 3% other sexual orientations. In addition, 99% reported being cisgender, and 0.2% reported being trans woman, trans man, and trans gender non-conforming, respectively. In the fully adjusted sexual orientation models, identifying as gay/lesbian was associated with a 27% increased likelihood of sleeping 8 hours and 71% increased likelihood of sleeping 10+ hours compared to heterosexuals. Self-identifying as bisexual and other orientations is associated with an 86% and 52% increased likelihood of sleeping 10+ hours, respectively. In the fully adjusted gender identity models, trans women were 115% more likely to report 8 hours of sleep, 122% more likely to report 9 hours of sleep, and 223% more likely to report 10+ hours of sleep. In the combined fully adjusted model, self-identifying as gay/lesbian, bisexual, or other orientations is associated with a 68%, 84%, and 63% increased likelihood of sleeping 10+ hours. Trans women are 149% more likely to report 10+ hours of sleep. Based on our empirical analyses, being a sexual and/or gender minority is associated with a greater likelihood of reporting 10+ hours of sleep.