Inicio escolar tardío para el apoyo de la educación, la salud y el bienestar de alumnos de educación secundaria
Appendices
Appendix 1. MEDLINE search strategy
1 Adolescent/
2 Students/
3 teen$.ab,ti.
4 adolescent$.ab,ti.
5 high school students.ab,ti.
6 "young person$".ab,ti.
7 "young people".ab,ti.
8 youth$.ab,ti.
9 Schools/
10 high school education.ab,ti.
11 secondary education.ab,ti.
12 secondary school.ab,ti.
13 "junior high school$".ab,ti.
14 middle school$.ab,ti.
15 "senior high school".ab,ti.
16 "high school$".ab,ti.
17 (start* adj3 tim*).ab,ti.
18 (late* adj3 start*).ab,ti.
19 (earl* adj3 start*).ab,ti.
20 (delay* adj3 start*).ab,ti.
21 (delay* adj3 time*).ab,ti.
22 (stagger$ adj3 start$).ab,ti.
23 (stagger$ adj3 tim$).ab,ti.
24 (split$ adj3 shift$).ab,ti.
25 (double adj3 session$).ab,ti.
26 (start$ adj2 school$).ab,ti.
27 (tim$ adj2 school$).ab,ti.
28 (time$ adj3 day).ab,ti.
29 (begin$ adj3 day).ab,ti.
30 (start$ adj3 day).ab,ti.
31 ((double$ or morning or afternoon or evening or different) adj3 shift$).ab,ti.
32 (tim$ adj3 learn$).ab,ti.
33 ((earl$ or late$ or school$) adj3 schedul$).ab,ti.
34 Wakefulness/
35 sleep.ab,ti.
36 chronobiology.ab,ti.
37 "human biological rhythm$".ab,ti.
38 circadian.ab,ti.
39 "phase shift".ab,ti.
40 or/1‐8
41 or/9‐16
42 or/17‐39
43 40 and 41 and 42
Appendix 2. Additional Search Strategies
PsycINFO ‐ February 4, 2016
(SU.EXACT("Adolescent Development") OR teen* or adolescent* or high school* or student*or “young person” or “young people” or youth*) AND (SU.EXACT("High Schools") OR SU.EXACT("High School Education") OR “high school education” OR “secondary education” OR “secondary school” OR “junior high school” OR “middle school” OR “senior high school” OR “high school”) AND (SU.EXACT("Wakefulness") OR SU.EXACT("Sleep") OR "start time" OR "late start" OR "early start" OR "delayed start" OR "delayed time" OR "staggered start" OR "split shift" OR "double session" OR "school start" OR "start school" OR "time at school" OR "school time" OR "time of day" OR "day time" OR "begin day" OR "start day" OR ((double OR morning OR afternoon OR evening OR different) AND shift) OR "timeto learn" OR "learning time" OR (early OR late OR school) AND schedule) OR sleep OR chronobiology OR "human biological rhythm" OR circadian OR "phase shift")
Embase Classic+Embase 1947 to 2016 January 29 ‐ February 1, 2016
1. adolescent/ or high school student/ or middle school student/ or teen$.ab,ti. or adolescent$.ab,ti. or high school student$.ab,ti. or young person$.ab,ti. or young people.ab,ti. or youth$.ab,ti.
2. high school/ or middle school/ or (high school education or secondary education or secondary school or junior high school$ or middle school$ or senior high school or high school$).ab,ti.
3. ((start* adj3 tim*) or (late* adj3 start*) or (earl* adj3 start*) or (delay* adj3 start*) or (delay* adj3 time*) or (stagger$ adj3 start$) or (stagger$ adj3 tim$) or (split$ adj3 shift$) or (double adj3 session$) or (start$ adj2 school$) or (tim$ adj2 school$) or (time$ adj3 day) or (begin$ adj3 day) or (start$ adj3 day) or ((double$ or morning or afternoon or evening or different) adj3 shift$) or (tim$ adj3 learn$) or ((earl$ or late$ or school$) adj3 schedul$)).ab,ti. or Wakefulness/ or sleep.ab,ti. or chronobiology.ab,ti. or human biological rhythm$.ab,ti. or circadian.ab,ti. or phase shift.ab,ti.
4. 1 and 2 and 3
Academic Search Complete ‐ February 4, 2016
(adolescent OR Students OR teen* OR adolescent* OR "high school students" OR "young person" OR "young people" OR youth*) AND ("high school education" OR "secondary education" OR "secondary school" OR "junior high school" OR "middle school" OR "senior high school" OR "high school") AND ((start*N2 tim*) OR (late* N2 start*) OR (earl* N2 start*) OR (delay* N2 start*) OR (delay* N2 time*) OR (stagger* N2start*) OR (stagger* N2 tim*) OR (split* N2 shift*) OR (double N2 session*) OR (start* N2 school*) OR (tim* N2 school*) OR (time* N2 day) OR (begin* N2 day) OR (start* N2 day) OR ((double* OR morning OR afternoon OR evening OR different) N2 shift*) OR (tim* N2 learn*) OR ((earl* or late* or
school*) N2 schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift")
CINAHL ‐ February 01, 2016
| S11 | S8 AND S9 AND S10 |
| S10 | S6 OR S7 |
| S9 | S4 OR S5 |
| S8 | S1 OR S2 OR S3 |
| S7 | ((start* adj3 tim*) OR (late* adj3 start*) OR (earl* adj3 start*) OR (delay* adj3 start*) OR (delay* adj3 time*) OR (stagger* adj3 start*) OR (stagger* adj3 tim*) OR (split* adj3 shift*) OR (double adj3 session*) OR (start* adj2 school*) OR (tim* adj2 school*) OR (time* adj3 day) OR (begin* adj3 day) OR (start* adj3 day) OR ((double* OR morning OR afternoon OR evening OR different) adj3 shift*) OR (tim* adj3 learn*) OR ((earl* or late* or school*) adj3 schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift") |
| S6 | (MH "Wakefulness") |
| S5 | ("high school education" OR "secondary education" OR "secondary school" OR "junior high school" OR "middle school" OR "senior high school" OR "high school") |
| S4 | (MH "Schools, Secondary") |
| S3 | (adolescent OR Students OR teen* OR adolescent* OR "high school students" OR "young person" OR "young people" OR youth*) |
| S2 | (MH "Students, High School") |
| S1 | (MH adolescence) |
ERIC ‐ February 4, 2016
(SU.EXACT("Adolescents") OR SU.EXACT("High School Students") OR teen* or adolescent* or high school* or student*or “young person” or “young people” or youth*) AND (SU.EXACT("High Schools") OR SU.EXACT("Junior High Schools") OR “high school education” OR “secondary education” OR “secondary school” OR “junior high school” OR “middle school” OR “senior high school” OR “high school”) AND (SU.EXACT("Sleep") OR ((start*NEAR tim*) OR (late* NEAR start*) OR (earl* NEAR start*) OR (delay* NEAR start*) OR (delay* NEAR time*) OR (stagger* NEAR start*) OR (stagger* NEAR tim*) OR (split* NEAR shift*) OR (double NEAR session*) OR (start* NEAR school*) OR (tim* NEAR school*) OR (time* NEAR day) OR (begin* NEAR day) OR (start* NEAR day) OR ((double* OR morning OR afternoon OR evening OR different) NEAR shift*) OR (tim* NEAR learn*) OR ((earl* or late* or school*) NEAR schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift")
Sociological Abstracts ‐ February 3, 2016
(SU.EXACT("Adolescents") OR SU.EXACT("High School Students") OR teen* or adolescent* or high school* or student*or “young person” or “young people” or youth*) AND (SU.EXACT("High Schools") OR SU.EXACT("Junior High Schools") OR “high school education” OR “secondary education” OR “secondary school” OR “junior high school” OR “middle school” OR “senior high school” OR “high school”) AND (SU.EXACT("Sleep") OR ((start*NEAR tim*) OR (late* NEAR start*) OR (earl* NEAR start*) OR (delay* NEAR start*) OR (delay* NEAR time*) OR (stagger* NEAR start*) OR (stagger* NEAR tim*) OR (split* NEAR shift*) OR (double NEAR session*) OR (start* NEAR school*) OR (tim* NEAR school*) OR (time* NEAR day) OR (begin* NEAR day) OR (start* NEAR day) OR ((double* OR morning OR afternoon OR evening OR different) NEAR shift*) OR (tim* NEAR learn*) OR ((earl* or late* or school*) NEAR schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift")
ProQuest Dissertations & Theses ‐ February 4, 2016
(adolescent OR Students OR teen* OR adolescent* OR "high school students" OR "young person" OR "young people" OR youth*) AND ("high school education" OR "secondary education" OR "secondary school" OR "junior high school" OR "middle school" OR "senior high school" OR "high school") AND ((start*NEAR tim*) OR (late* NEAR start*) OR (earl* NEAR start*) OR (delay* NEAR start*) OR (delay* NEAR time*) OR (stagger* NEAR start*) OR (stagger* NEAR tim*) OR (split* NEAR shift*) OR (double NEAR session*) OR (start* NEAR school*) OR (tim* NEAR school*) OR (time* NEAR day) OR (begin* NEAR day) OR (start* NEAR day) OR ((double* OR morning OR afternoon OR evening OR different) NEAR shift*) OR (tim* NEAR learn*) OR ((earl* or late* or school*) NEAR schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift")
The Cochrane Collaboration of Systematic Reviews – February 4, 2016
(adolescent OR Students OR teen* OR adolescent* OR "high school students" OR "young person" OR "young people" OR youth*) AND ("high school education" OR "secondary education" OR "secondary school" OR "junior high school" OR "middle school" OR "senior high school" OR "high school") AND ((start* tim*) OR (late* start*) OR (earl* start*) OR (delay* start*) OR (delay* time*) OR (stagger* start*) OR (stagger* tim*) OR (split* shift*) OR (double session*) OR (start* school*) OR (tim* school*) OR (time* day) OR (begin* day) OR (start* day) OR ((double* OR morning OR afternoon OR evening OR different) shift*) OR (tim* learn*) OR ((earl* or late* or school*) schedul*) OR Wakefulness OR sleep OR chronobiology OR "human biological rhythm" OR "human biological rhythms" OR circadian OR "phase shift")
Bibliomap ‐ February 4, 2016
(adolescent OR student OR teen OR teenager OR "young person" OR "young people" or youth) AND ("high school" OR "secondary school" OR "middle school") AND ("early start" OR "start school" OR "school time" OR "learning time" OR "time to learn" OR sleep OR circadian)
DoPHER ‐ February 4, 2016
(adolescent OR student OR teen) AND ("high school" OR "secondary school" OR "secondary education") AND ("start time" OR "school start" OR "start school" OR "school time" OR "start day" OR sleep OR circadian)
TRoPHI ‐ February 4, 2016
(adolescent OR student OR teen) AND ("high school" OR "secondary school" OR "secondary education") AND ("start time" OR "school start" OR "school time" OR "start day" OR sleep OR circadian)
Database of Education Research ‐ February 4, 2016
(adolescent* OR student* OR teen* OR youth*) AND ("high school" OR "secondary school" OR "secondary education" OR "high school education") AND (time)
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 Early school start vs late school start, outcome: 1.1 School‐night sleep duration.
Forest plot of comparison: 1 Early school start vs Late school start, outcome: 1.2 BMI Score ‐ Cross‐over trial.
Forest plot of comparison: 1 Early school start vs Late school start, outcome: 1.3 Waist Circumference ‐ Cross‐over trial.
Forest plot of comparison: 1 Early school start vs Late school start, outcome: 1.4 Body Fat ‐ Cross‐over trial.
Comparison 1 Early school start vs late school start, Outcome 1 School‐night sleep duration.
Comparison 1 Early school start vs late school start, Outcome 2 BMI score ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 3 Waist circumference ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 4 Body fat ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 5 School‐night sleep duration ‐ RCT.
Comparison 1 Early school start vs late school start, Outcome 6 Concentration performance ‐ RCT.
Comparison 1 Early school start vs late school start, Outcome 7 Attention level ‐ RCT.
Comparison 1 Early school start vs late school start, Outcome 8 Peer support ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 9 Social support ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 10 Extracurricular activities ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 11 Academics ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 12 Risk of losing sleep ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 13 Overly sleepy ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 14 Sleepiness ‐ QED.
Comparison 1 Early school start vs late school start, Outcome 15 Percentage of students getting adequate sleep.
| Early versus delayed school starts | |||
| Patient or population: students aged 13‐19 | |||
| Outcomes | Impacts | № of Participants (studies) | Quality of the evidence |
| Student academic outcomes | There is no clear association between later school start times and student academic outcomes, as two studies reported significant positive associations (b = 1.78, b = 0.98; effect sizes could not be calculated from one study), one study reported a non‐significant negative association (b = −0.02), and one study reported a significant negative association (MD −0.32 GPA points on a scale of 0 to 4, with higher GPAs indicating better grades). | 254,743 (4) | ⊕⊝⊝⊝ |
| Amount or quality of sleep | All studies that evaluated the association between later school start times and amount or quality of sleep reported significant positive associations, providing evidence that later school start times are associated with increased sleep (effect sizes ranged from MD 0.49 to 1.95 hours) and lower risk of losing sleep (RR 0.41). | 52,340 (8) | ⊕⊝⊝⊝ |
| Mental health outcomes | There is limited evidence concerning the association between later school start times and mental health outcomes: one study reported significant differences in self‐reported depression symptoms for students in later starting schools (07:25 and 08:30) than earlier starting schools (07:15), but no significant difference between students starting school at 08:30 vs 07:25. | 1200 (1) | ⊕⊝⊝⊝ |
| Truancy or attendance outcomes | There is mixed evidence concerning the association between later school starts and attendance outcomes: one study reported a significant increase in attendance, one study reported a non‐significant increase in attendance, and one study reported a significant increase in attendance for 2 of 6 schools and non‐significant effects (no further information provided) for the other 4 schools. | 255,122 (4) | ⊕⊝⊝⊝ |
| Alertness | There is mixed evidence concerning the association between later school starts and student reports of alertness or sleepiness. Two studies found an association between later school start times and decreased daytime sleepiness, while one study found no difference between student reports at later and earlier starting schools. One study reported a significant increase in attention levels but a non‐significant increase in concentration levels. | 2735 (4) | ⊕⊝⊝⊝ |
| Adverse events/unintended consequences | Authors provided limited information concerning adverse events and unintended consequences but did offer that later school start times may be associated with decreased morning interactions between parents and children, decreased alertness in mid‐afternoon, and increased logistical challenges, including missing extracurricular activities, transportation troubles, and safety concerns (as students may have to walk home in the dark). | 207,576 (4) | ⊕⊝⊝⊝ |
| b: regression coefficient; CI: confidence interval; GPA: grade point average; MD: mean difference; RR: risk ratio | |||
| GRADE Working Group grades of evidence | |||
| aDowngraded one level (from starting point of 'low' for observational study designs). The GRADE rating of 'very low' for all findings reflects study designs (absence of RCTs), high risk of bias within the studies, and inconsistency within the estimates. | |||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 School‐night sleep duration Show forest plot | 2 | 1022 | Mean Difference (IV, Random, 95% CI) | 1.39 [0.38, 2.39] |
| 2 BMI score ‐ QED Show forest plot | 1 | 379 | Mean Difference (IV, Random, 95% CI) | ‐0.08 [‐0.30, 0.13] |
| 3 Waist circumference ‐ QED Show forest plot | 1 | 379 | Mean Difference (IV, Random, 95% CI) | ‐1.14 [‐3.34, 1.06] |
| 4 Body fat ‐ QED Show forest plot | 1 | 379 | Mean Difference (IV, Random, 95% CI) | ‐1.45 [‐2.63, ‐0.27] |
| 5 School‐night sleep duration ‐ RCT Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6 Concentration performance ‐ RCT Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 7 Attention level ‐ RCT Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 8 Peer support ‐ QED Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 9 Social support ‐ QED Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 10 Extracurricular activities ‐ QED Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 11 Academics ‐ QED Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 12 Risk of losing sleep ‐ QED Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 13 Overly sleepy ‐ QED Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 14 Sleepiness ‐ QED Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 15 Percentage of students getting adequate sleep Show forest plot | 1 | 905 | Risk Ratio (M‐H, Random, 95% CI) | 1.50 [1.33, 1.70] |
