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

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 Citation: Morgenthaler TI, Hashmi S, Croft JB, Dort L, Heald JL, Mullington J. High school start times and the impact on high school students: what we know, and what we hope to learn.

0158 Chronotypes in the Us - Influence of Age and Sex

“…Our findings suggest that adolescents' chronotypes are on average too late for school start times before 8:30 a.m., i.e., many may not be able to advance their sleep enough to get sufficient sleep, which is in line with another CDC report showing that 68.8% of US high school students sleep less than 8h during an average school night [32]. Evidence is mounting that one simple and effective (yet not the only) way to benefit adolescent sleep is to delay school start times [33].…”

Later School Start Time: The Impact of Sleep on Academic Performance and Health in the Adolescent Population

“…Unlike previous works [103][104][105][106], systematic and meta-analytic analysis is beyond the scope of this review, and this entailed some basic limitations. Indeed, a rigorous methodological quality review of the included literature was not undertaken, and, consequently, some of the cited studies are less rigorous and have more potential bias than others.…”

“…Recent systematic [103][104][105] and meta-analytic [106] reviews provided a qualitative and quantitative synthesis of the strength of delayed school programs in improving several sleep-related outcome variables. The outcomes, mostly estimated by sleep habits survey, illustrated the effectiveness of these programs on rising time, bedtime, or time spent in sleeping.…”

“…The specific conditions were not standardized across studies, ranging from a minimum of 20 to a maximum of 60 min of delay. However, a 60 min change between early and later start times seems to be a critical threshold in determining the effects [104], as shown by a net gain of TST when the delay was greater than 60 min [108,110,124,129]. Generally, the increase in minutes of sleep ranges from 25 min to 77 min per night [105].…”

Later School Start Times: What Informs Parent Support or Opposition?

“…26 Further support for a positive effect of later SSTs on sleep duration, as well as reduced car accidents and daytime sleepiness, was provided in a recent evidence-based review. 37 However, this study found only weak evidence overall for the association of later SSTs and improved academic performance and behavioral health.…”