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J Adolesc Health. 2017 Aug;61(2):205-211. doi: 10.1016/j.jadohealth.2017.02.017. Epub 2017 May 3.

Variable School Start Times and Middle School Student's Sleep Health and Academic Performance.

Author information

Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC. Electronic address:
Department of Developmental and Behavioral Pediatrics, Institute, Shanghai Children's Medical Center, Shanghai, China; School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC.
Department of Psychology, University of Wisconsin, Madison, Wisconsin.
Nationwide Children's Hospital, Department of Psychology, Baltimore County, Baltimore, Maryland.
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.



Improving sleep health among adolescents is a national health priority and implementing healthy school start times (SSTs) is an important strategy to achieve these goals. This study leveraged the differences in middle school SST in a large district to evaluate associations between SST, sleep health, and academic performance.


This cross-sectional study draws data from a county-wide surveillance survey. Participants were three cohorts of eighth graders (n = 26,440). The school district is unique because SST ranged from 7:20 a.m. to 8:10 a.m. Path analysis and probit regression were used to analyze associations between SST and self-report measures of weekday sleep duration, grades, and homework controlling for demographic variables (sex, race, and socioeconomic status). The independent contributions of SST and sleep duration to academic performance were also analyzed.


Earlier SST was associated with decreased sleep duration (χ2 = 173, p < .0001) and deficient sleep (≤7 hours) among 45% of students. Students with SST before 7:45 a.m. were at increased risk of decreased sleep duration, academic performance, and academic effort. Path analysis models demonstrated the independent contributions of sleep duration, SST, and variable effects for demographic variables.


This is the first study to evaluate the independent contributions of SST and sleep to academic performance in a large sample of middle school students. Deficient sleep was prevalent, and the earliest SST was associated with decrements in sleep and academics. These findings support the prioritization of policy initiatives to implement healthy SST for younger adolescents and highlight the importance of sleep health education disparities among race and gender groups.


Academics; Adolescent; Middle school; School start times; Sleep

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