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Transgender patients require careful clinical assessment to identify the effects of hormones on their risk of obstructive sleep apnea. Testosterone increases sleep apnea risk and assigned males at birth may develop the condition earlier. Estrogen and progesterone are known to reduce sleep apnea risk. Depending on the use of supplemental hormones and surgical status, the risk of sleep apnea may be altered in a transgender patient. Comorbid conditions, including mood disorders and obesity, may further impact sleep. This topic has not been well-studied, and this pilot project identifies special needs that exist in transgender populations. Methods This retrospective chart review included 25 subjects who identify as transgender who have been managed at an urban sleep disorders center from 2017 to 2019. The case series was assessed to identify characteristics that impact the diagnosis and treatment of obstructive sleep apnea (natural and supplemental hormonal effects, surgical effects, comorbid conditions, etc.). Results The average age of the cohort was 34 years (range 16 to 76). Fourteen subjects were assigned females at birth and identify as men and 11 subjects were assigned males at birth and identify as women. Preferred pronoun usage was concordant with gender identity in 21 subjects, discordant in 1 subject, and gender-neutral (they/them) was used by 3 subjects. Based on 24 subjects, the average BMI was 35.5 (range 23.5 to 53.1). The measured neck circumference was &amp;lt;16 inches in 9 subjects, &amp;gt;17 inches in 6 subjects,and a risk factor for sleep apnea based on birth-assigned sex but not gender identity in 4 subjects. Hormone therapy was used by 24 subjects to enhance their gender identities. When documented, 6 subjects had mastectomies and 2 also had total hysterectomies. Anxiety or depression had been diagnosed in 20 subjects. Testing revealed sleep apnea in 18 subjects. Loss to follow up affected 9 subjects. Conclusion Transgender patients deserve respectful evaluation and careful consideration regarding risk factors for obstructive sleep apnea that may be impacted by gender-affirming hormonal therapy or surgery, and weight gain. Higher rates of mood disorders and loss to follow up may put these patients at long-term risk. Support

0598 Blurred Binaries: The Clinical Management of Obstructive Sleep Apnea in Transgender Patients