title: High School Start Times and the Impact on High School Students: What We Know, and What We Hope to Learn.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
authors.affiliation: American Academy of Sleep Medicine, Darien, IL.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Dort
authors.affiliation: American Academy of Sleep Medicine, Darien, IL.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Heald
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Janet
authors.initials: J
authors.lastname: Mullington
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000124:Achievement; D000293:Adolescent; D000294:Adolescent Behavior; D002940:Circadian Rhythm / Q000502:physiology*; D006801:Humans; D007858:Learning / Q000502:physiology*; D012574:Schools; D012890:Sleep / Q000502:physiology; D012892:Sleep Deprivation / Q000503:physiopathology*; D013334:Students; D013995:Time
keywords: high school; sleep start time; timing