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Review
. 2016 Dec 15;12(12):1681-1689.
doi: 10.5664/jcsm.6358.

High School Start Times and the Impact on High School Students: What We Know, and What We Hope to Learn

Timothy I Morgenthaler  1 , Sarah Hashmi  2 , Janet B Croft  3 , Leslie Dort  4 , Jonathan L Heald  2 , Janet Mullington  5
Affiliations
Review

High School Start Times and the Impact on High School Students: What We Know, and What We Hope to Learn

Timothy I Morgenthaler et al. J Clin Sleep Med. .

Abstract

Study objectives: Several organizations have provided recommendations to ensure high school starts no sooner than 08:30. However, although there are plausible biological reasons to support such recommendations, published recommendations have been based largely on expert opinion and a few observational studies. We sought to perform a critical review of published evidence regarding the effect of high school start times on sleep and other relevant outcomes.

Methods: We performed a broad literature search to identify 287 candidate publications for inclusion in our review, which focused on studies offering direct comparison of sleep time, academic or physical performance, behavioral health measures, or motor vehicular accidents in high school students. Where possible, outcomes were combined for meta-analysis.

Results: After application of study criteria, only 18 studies were suitable for review. Eight studies were amenable to meta-analysis for some outcomes. We found that later school start times, particularly when compared with start times more than 60 min earlier, are associated with longer weekday sleep durations, lower weekday-weekend sleep duration differences, reduced vehicular accident rates, and reduced subjective daytime sleepiness. Improvement in academic performance and behavioral issues is less established.

Conclusions: The literature regarding effect of school start time delays on important aspects of high school life suggests some salutary effects, but often the evidence is indirect, imprecise, or derived from cohorts of convenience, making the overall quality of evidence weak or very weak. This review highlights a need for higher-quality data upon which to base important and complex public health decisions.

Keywords: high school; sleep start time; timing.

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Figures

Figure 1
Figure 1. PRISMA diagram for literature search to examine effect of high school start times on outcomes of interest.
Figure 2
Figure 2. Average response or magnitude of effect across all studies for the effect of school start time differences 60 min or less on total school-night sleep time.
Figure 3
Figure 3. Average response or magnitude of effect across all studies for effect of school start time differences 60 min or less on measured sleepiness during the school day.
Figure 4
Figure 4. Average response or magnitude of effect across all studies for the effect of school start time differences 60 min or more on total school-night sleep time.
Figure 5
Figure 5. Average response or magnitude of effect across all studies for the effect of school start time differences 60 min or less on nonschool night sleep time.
Figure 6
Figure 6. Average response or magnitude of effect for the effect of school start time differences more than 60 min on nonschool night sleep time.
See this image and copyright information in PMC

Comment in

  • Commentary on Healthy School Start Times.
    Owens J, Troxel W, Wahlstrom K. Owens J, et al. J Clin Sleep Med. 2017 May 15;13(5):761. doi: 10.5664/jcsm.6602. J Clin Sleep Med. 2017. PMID: 28212695 Free PMC article. No abstract available.
  • Transparency and Partnership.
    Morgenthaler TI, Dort L, Mullington J. Morgenthaler TI, et al. J Clin Sleep Med. 2017 May 15;13(5):763. doi: 10.5664/jcsm.6604. J Clin Sleep Med. 2017. PMID: 28356175 Free PMC article. No abstract available.

References

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    1. Centers for Disease Control and Prevention. Healthy People 2020. August 12 2016 [cited 2016 August 15]; Available from: http://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health.
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