Perceptions of school start times and adolescent sleep by WHO region.

Early school start times are widely reported as a major contributor to adolescent sleep insufficiency. Although prior research indicates that later school start times are associated with improved adolescent sleep, region-specific challenges are perceived to complicate implementation. This study aimed to examine reported variations in school start times and adolescent sleep patterns across World Health Organization (WHO) regions, and to summarise perceived barriers and potential solutions for implementing sleep-promoting start times globally. An online survey was administered to members of the International Pediatric Sleep Association and invited participants from the World Sleep Society. Respondents were asked to estimate typical school start times, bedtimes, rise times, and sleep duration for middle and high school students in their respective countries. Respondents commonly reported early school start times across WHO regions with 51% reporting middle schools, and 52% reporting high schools, frequently starting before 8:00 am. Reported patterns varied by region, with early start times perceived as most common in the Americas, South-East Asia, Eastern Mediterranean, and African regions, and later start times more frequently reported in Europe and the Western Pacific. Respondents also reported concerning perceptions of adolescent sleep adequacy: 43% indicated that most middle school students in their country were perceived to obtain less than the recommended 8 hours of sleep per night, increasing to 70% reporting this for high school students. Frequently reported barriers to adopting healthier start times included parental, governmental, and school-level resistance, while proposed solutions emphasised education, stakeholder collaboration, and legislative approaches to support later start times. These findings highlight widespread reported concerns regarding adolescent sleep duration and the perceived global challenges associated with modifying school start times. Region-specific strategies, informed by local contexts and stakeholder perspectives, may be required to address barriers and support the adoption of later, sleep-promoting school schedules. ● Middle and high schools are frequently reported to start before 8:00 am worldwide. ● Reported start times vary; Europe and Western Pacific lean towards later starts. ● Experts reported students in their region (43% for middle and 70% for high school) sleep less than 8 hours nightly. ● Early starts and short sleep pose health risks, indicating a need for region-based policy changes.