{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2991-s0",
  "verdict_number": "2991",
  "title": "Didgeridoo training × daytime sleepiness in moderate OSA",
  "view_version": "1.0",
  "view_created_date": "2026-10-16",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "The original records 25 adults with moderate obstructive sleep apnea (OSA), BMI below 30 and AHI 15–30/h, all completing follow-up. Age, sex, eligibility details, baseline ESS, arm allocation and endpoint analysis denominators are unverified. This is not generalized to all BMIs, severities or ages; completion by everyone does not fill complete analyses for every endpoint.",
    "intervention": "A structured didgeridoo lesson/home-practice program. This is not converted into a specific instrument-brand effect or equivalent effects from all playing/breathing training. Components, contact, individual actual practice and adherence are unverified. No new playing/breathing methods or procedures are created.",
    "dose": "Original mean 5.9 days weekly, 25.3 minutes per session and approximately 25 minutes in the intervention name are preserved only as study exposure. Plans, individual distributions, discontinuation and adherence details are unverified. Means do not become identical exposure for everyone or a recommended schedule; total time, frequency and individual intensity are not newly converted.",
    "comparator": "A four-month wait-list control. Contact, expectation differences and concurrent-treatment details are unverified. This is not converted into direct comparisons, equivalence or treatment-replacement effects versus standard CPAP, oral appliances, other instruments or equal-contact sham.",
    "endpoint": "The selected endpoint is four-month Epworth Sleepiness Scale (ESS), with between-group difference −3.0 points (95% CI −5.7 to −0.3, P=.03). AHI −6.2/h (−12.3 to −0.1, P=.05), null PSQI −0.7 points (−2.1 to 0.6, P=.27) and subjective bed-partner assessment −2.8 points are separate. Exact models, denominators and prerecruitment hierarchy are unverified. Units, respondents and endpoints are not mixed; no new effects, CIs or cure rates are created.",
    "duration": "Original four-month assessment and completion by all 25 participants. Boundaries of unverified/untested later ESS persistence, post-intervention change, long-term complication prevention and standard-treatment replacement are retained. Short-term symptom/sleep-study results are not extended to long-term clinical outcomes or safety of stopping established treatment.",
    "excluded_extensions": [
      "Mixing ESS points, AHI/h, PSQI and bed-partner assessment as the same unit, respondent, endpoint or cure rate",
      "Transferring an unblinded wait-list ESS signal into direct comparisons, equivalence, noninferiority or replacement effects versus CPAP/oral appliances",
      "Filling arm n, every endpoint denominator or ITT from all 25 completing, or adding paper/registration/two subclaim sheets as independent trials/participants",
      "Inheriting retrospective registration or original historical checks as prerecruitment plans, current external reading or completed clinical review",
      "Extending parent C50, Good and axes into subclaim scores, all BMIs/severities, long-term clinical effects or safety",
      "Creating new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which daytime-sleepiness claim is examined?",
      "needed": "Selected sleepiness claim, note/grade and parent verdict",
      "role": "Required",
      "role_reason": "This condition connects Selected sleepiness claim, note/grade and parent verdict with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Selected sleepiness claim, note/grade and parent verdict must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Separate subclaim score, status and axes are absent from the original. The selected claim and parent verdict must be distinguished. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The selected claim is reduced daytime sleepiness in moderate OSA. Original grade C and the ESS between-group difference of −3.0 points in its note are retained. Subclaim score, status and axes are absent; parent C50 does not fill a subclaim score.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Separate subclaim score, status and axes are absent from the original. The selected claim and parent verdict must be distinguished.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Separate subclaim score, status and axes are absent from the original. The selected claim and parent verdict must be distinguished."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Which adults with moderate OSA were studied?",
      "needed": "Eligibility, baseline characteristics, diagnosis and arm denominators",
      "role": "Required",
      "role_reason": "This condition connects Eligibility, baseline characteristics, diagnosis and arm denominators with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Eligibility, baseline characteristics, diagnosis and arm denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact age, sex, baseline ESS, diagnostic procedures and arm allocation denominators are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original population is 25 adults with moderate OSA, BMI below 30 and AHI 15–30/h. This is not extended to every BMI, severity, age or sleep-disorder population.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact age, sex, baseline ESS, diagnostic procedures and arm allocation denominators are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact age, sex, baseline ESS, diagnostic procedures and arm allocation denominators are unverified."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Which program was studied?",
      "needed": "Lessons, home practice, developer and intervention specification",
      "role": "Required",
      "role_reason": "This condition connects Lessons, home practice, developer and intervention specification with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Lessons, home practice, developer and intervention specification must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Lesson components, contact, individual actual practice and generalizable components are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records a structured didgeridoo lesson/home-practice program. This is not changed into a particular instrument-brand effect or an equivalent effect from all playing/breathing training.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Lesson components, contact, individual actual practice and generalizable components are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Lesson components, contact, individual actual practice and generalizable components are unverified."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Does average practice describe an individual procedure?",
      "needed": "Planned exposure, mean actual exposure, distribution and adherence",
      "role": "Required",
      "role_reason": "This condition connects Planned exposure, mean actual exposure, distribution and adherence with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Planned exposure, mean actual exposure, distribution and adherence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Planned exposure, individual distributions, discontinuation, adherence assessment and ESS by exposure are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Mean 5.9 days weekly, 25.3 minutes per session and approximately 25 minutes in the original intervention name describe study exposure. They are not treated as equal exposure for everyone or recommended procedures, and totals are not newly converted.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Planned exposure, individual distributions, discontinuation, adherence assessment and ESS by exposure are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Planned exposure, individual distributions, discontinuation, adherence assessment and ESS by exposure are unverified."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "What does the wait-list comparison establish?",
      "needed": "Control care, contact, expectations and concurrent treatment",
      "role": "Required",
      "role_reason": "This condition connects Control care, contact, expectations and concurrent treatment with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Control care, contact, expectations and concurrent treatment must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Paper S01 is a randomized wait-list comparison. It is not a direct comparison with standard OSA therapy, another instrument or equal-contact sham.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Are randomization and concealment detailed?",
      "needed": "Allocation sequence, concealment and recruitment processes",
      "role": "Required",
      "role_reason": "This condition connects Allocation sequence, concealment and recruitment processes with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Allocation sequence, concealment and recruitment processes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The S01 design and stored report record random allocation. The summary does not establish sequence generation, allocation concealment or processes before/after recruitment.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Is unblinded symptom assessment distinguished?",
      "needed": "Participant, assessor/analyst masking and expectation differences",
      "role": "Required",
      "role_reason": "This condition connects Participant, assessor/analyst masking and expectation differences with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Participant, assessor/analyst masking and expectation differences must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Assessor/analyst masking, contact/expectation differences and their control are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The stored report states that participants knew their intervention and identifies unblinded subjective symptom assessment as a limitation. Objective AHI does not substitute for ESS masking or control of expectation effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Assessor/analyst masking, contact/expectation differences and their control are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Assessor/analyst masking, contact/expectation differences and their control are unverified."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "What did ESS assess and when?",
      "needed": "Scale, assessment window, method and units",
      "role": "Required",
      "role_reason": "This condition connects Scale, assessment window, method and units with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Scale, assessment window, method and units must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The S01 main endpoint is the four-month Epworth Sleepiness Scale (ESS) score. AHI/h, PSQI and bed-partner disturbance are different measures.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What is the original ESS difference, CI and P value?",
      "needed": "Comparative estimate, units, denominators and model",
      "role": "Required",
      "role_reason": "This condition connects Comparative estimate, units, denominators and model with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Comparative estimate, units, denominators and model must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original arm values, exact analysis denominators, model, baseline adjustment and outcome-hierarchy details are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The ESS between-group difference of −3.0 points (95% CI −5.7 to −0.3, P=.03) is preserved. It is not transferred into within-arm change, treatment-replacement differences or cure rates.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original arm values, exact analysis denominators, model, baseline adjustment and outcome-hierarchy details are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original arm values, exact analysis denominators, model, baseline adjustment and outcome-hierarchy details are unverified."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Are ESS importance and individual distributions verified?",
      "needed": "Relevance thresholds, individual changes and uncertainty",
      "role": "Required",
      "role_reason": "This condition connects Relevance thresholds, individual changes and uncertainty with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Relevance thresholds, individual changes and uncertainty must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Prior relevance thresholds, individual distributions, response definitions and persistence are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The stored report describes a symptom signal from one small trial. −3.0 points and statistical significance alone do not establish perceived or clinically important improvement for every participant.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Prior relevance thresholds, individual distributions, response definitions and persistence are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Prior relevance thresholds, individual distributions, response definitions and persistence are unverified."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Did effects persist after four months?",
      "needed": "Assessment duration, intervention cessation and long-term follow-up",
      "role": "Required",
      "role_reason": "This condition connects Assessment duration, intervention cessation and long-term follow-up with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Assessment duration, intervention cessation and long-term follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: ESS persistence beyond four months, post-intervention changes and long-term clinical outcomes have no linked material. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original study assessed four months. Original statements that long-term complication prevention and standard-treatment replacement were not tested are preserved separately.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "ESS persistence beyond four months, post-intervention changes and long-term clinical outcomes have no linked material.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "ESS persistence beyond four months, post-intervention changes and long-term clinical outcomes have no linked material."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Is AHI a separate result from ESS?",
      "needed": "Distinguishing ESS/AHI definitions, results and units",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing ESS/AHI definitions, results and units with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Distinguishing ESS/AHI definitions, results and units must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Sleep-study methods, AHI calculation, condition-specific denominators and exact prior analysis plans are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The AHI between-group difference of −6.2/h (−12.3 to −0.1, P=.05) is a separate sleep-study result. Its same-direction original signal is preserved without transfer to ESS effects/scores, cure or equivalence to standard therapy.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Sleep-study methods, AHI calculation, condition-specific denominators and exact prior analysis plans are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Sleep-study methods, AHI calculation, condition-specific denominators and exact prior analysis plans are unverified."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Is the null PSQI result also retained?",
      "needed": "Endpoint-specific effects, units and uncertainty",
      "role": "Required",
      "role_reason": "This condition connects Endpoint-specific effects, units and uncertainty with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Endpoint-specific effects, units and uncertainty must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: PSQI procedures, denominators, model and prespecified hierarchy are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "PSQI −0.7 points (−2.1 to 0.6, P=.27) is described as null in the original. The sleepiness signal is not transferred to overall sleep-quality improvement, and nonsignificance does not become an exact zero effect.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "PSQI procedures, denominators, model and prespecified hierarchy are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "PSQI procedures, denominators, model and prespecified hierarchy are unverified."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Are the bed-partner respondent and endpoint distinguished?",
      "needed": "Respondent, scale, endpoint and denominators",
      "role": "Required",
      "role_reason": "This condition connects Respondent, scale, endpoint and denominators with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Respondent, scale, endpoint and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Bed-partner denominators, scale, exact CIs/P values, masking and prior hierarchy are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original describes a −2.8-point improvement in bed-partner sleep disturbance as subjective assessment. It is not transferred to patient ESS, objective AHI or direct replication in an independent trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Bed-partner denominators, scale, exact CIs/P values, masking and prior hierarchy are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Bed-partner denominators, scale, exact CIs/P values, masking and prior hierarchy are unverified."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Does completion by everyone establish every analysis denominator?",
      "needed": "Allocation, completion, endpoint analyses and missingness",
      "role": "Required",
      "role_reason": "This condition connects Allocation, completion, endpoint analyses and missingness with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Allocation, completion, endpoint analyses and missingness must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Arm allocation, endpoint analysis denominators, missingness, ITT/PP and exclusion reasons are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records all 25 participants completing follow-up. This does not automatically fill arm n, complete ESS/AHI/PSQI analyses or ITT/PP status.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Arm allocation, endpoint analysis denominators, missingness, ITT/PP and exclusion reasons are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm allocation, endpoint analysis denominators, missingness, ITT/PP and exclusion reasons are unverified."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Are concurrent treatment, weight and lifestyle changes verified?",
      "needed": "Arm-specific concurrent care, exposure and adjustment",
      "role": "Required",
      "role_reason": "This condition connects Arm-specific concurrent care, exposure and adjustment with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Arm-specific concurrent care, exposure and adjustment must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The comparison is lessons/home practice versus waiting. The summary is not extended to certify control or absence of concurrent OSA therapy, weight changes or lifestyle changes.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "When was ISRCTN registration made?",
      "needed": "Registration identity, recruitment/registration timing and original records",
      "role": "Required",
      "role_reason": "This condition connects Registration identity, recruitment/registration timing and original records with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Registration identity, recruitment/registration timing and original records must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact recruitment/registration dates, original registration and change-history details remain unread. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The preserved registration is ISRCTN31571714; the original records registration after recruitment began. Its identifier/URL does not establish current registration reading or verification of prerecruitment registration.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact recruitment/registration dates, original registration and change-history details remain unread.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact recruitment/registration dates, original registration and change-history details remain unread."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Does an ESS main endpoint establish the complete prior plan?",
      "needed": "Separating main-endpoint wording, registration, protocol and SAP",
      "role": "Required",
      "role_reason": "This condition connects Separating main-endpoint wording, registration, protocol and SAP with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Separating main-endpoint wording, registration, protocol and SAP must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original evidence item records four-month ESS as the main endpoint; historical grading describes separation of ESS/AHI/PSQI. In the retrospective-registration context, this is not converted into verified prerecruitment hierarchy or a completely reviewed SAP.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Are multiple endpoints and test models distinguished?",
      "needed": "All endpoints, tests, adjustment and multiplicity",
      "role": "Required",
      "role_reason": "This condition connects All endpoints, tests, adjustment and multiplicity with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for All endpoints, tests, adjustment and multiplicity must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Test direction, exact models, covariates, multiplicity and prior plans for additional endpoints are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "ESS, AHI, PSQI and subjective bed-partner assessment are different results. Some significant results are not extended to success of all endpoints or prior multiplicity adjustment.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Test direction, exact models, covariates, multiplicity and prior plans for additional endpoints are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Test direction, exact models, covariates, multiplicity and prior plans for additional endpoints are unverified."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are the paper and registration separate trials?",
      "needed": "Reports, registration, trial family and population links",
      "role": "Required",
      "role_reason": "This condition connects Reports, registration, trial family and population links with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Reports, registration, trial family and population links must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Detailed original/registration plans and correspondence between analyses remain externally unread. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The S01 Puhan 2006 paper and S02 ISRCTN31571714 registration are preserved links to the same 25-person four-month trial. Registration is not counted as another sleepiness-effect report, new participants or an independent trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed original/registration plans and correspondence between analyses remain externally unread.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed original/registration plans and correspondence between analyses remain externally unread."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Was the sleepiness effect independently replicated?",
      "needed": "Separate trials with the same population/intervention/comparator",
      "role": "Required",
      "role_reason": "This condition connects Separate trials with the same population/intervention/comparator with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Separate trials with the same population/intervention/comparator must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Separate replication under the same conditions and actual trial-family independence are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The stored report states that independent replication was absent. Multiple endpoints, paper/registration and two subclaim sheets from one trial do not become independent replication.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Separate replication under the same conditions and actual trial-family independence are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Separate replication under the same conditions and actual trial-family independence are unverified."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Does this apply to other BMIs, severities or ages?",
      "needed": "Direct population-specific material and subgroup plans",
      "role": "Required",
      "role_reason": "This condition connects Direct population-specific material and subgroup plans with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Direct population-specific material and subgroup plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Population-specific ESS, AHI, safety and prior subgroup plans have no linked material. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The direct population is selected adults with BMI below 30 and AHI 15–30/h. The same effects are not generalized to other severities, BMIs, ages or diseases.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Population-specific ESS, AHI, safety and prior subgroup plans have no linked material.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Population-specific ESS, AHI, safety and prior subgroup plans have no linked material."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Do sleepiness/AHI signals establish replacement of standard therapy?",
      "needed": "Direct standard-treatment comparisons and clinical outcomes",
      "role": "Required",
      "role_reason": "This condition connects Direct standard-treatment comparisons and clinical outcomes with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Direct standard-treatment comparisons and clinical outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Direct standard-treatment comparisons, noninferiority and long-term clinical outcomes have no linked material. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent report describes a wait-list signal and states that noninferiority/replacement versus CPAP or oral appliances was not tested. Sleepiness results do not establish equal standard-treatment effects, cure or grounds to stop treatment.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Direct standard-treatment comparisons, noninferiority and long-term clinical outcomes have no linked material.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Direct standard-treatment comparisons, noninferiority and long-term clinical outcomes have no linked material."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are funding, the developer-instructor and conflicts distinguished?",
      "needed": "Original support, product, employee/developer and COI records",
      "role": "Required",
      "role_reason": "This condition connects Original support, product, employee/developer and COI records with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Original support, product, employee/developer and COI records must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Funding roles, equipment/instrument support, developer-instructor roles, employee authors, COI and analysis/reporting involvement are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original funding records Zurich Lung Association/clinical support and a training developer-instructor among the authors. This is not converted into complete conflict verification or independence certification.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Funding roles, equipment/instrument support, developer-instructor roles, employee authors, COI and analysis/reporting involvement are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Funding roles, equipment/instrument support, developer-instructor roles, employee authors, COI and analysis/reporting involvement are unverified."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "What was reported about safety and sample-size limits?",
      "needed": "Harm collection, exposure, arm denominators and follow-up",
      "role": "Supplementary",
      "role_reason": "This condition connects Harm collection, exposure, arm denominators and follow-up with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Harm collection, exposure, arm denominators and follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Collection methods, event definitions, arm denominators, rare/long-term harms and treatment-cessation material are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original parent safety label is Good; no unexpected/adverse events were reported in 25 people over four months. This is not extended to absence of rare harms, long-term safety or safety of stopping established treatment.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Collection methods, event definitions, arm denominators, rare/long-term harms and treatment-cessation material are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Collection methods, event definitions, arm denominators, rare/long-term harms and treatment-cessation material are unverified."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Are parent values, subclaim grade and the evidence date separated?",
      "needed": "Parent/subclaim original values and historical dates",
      "role": "Required",
      "role_reason": "This condition connects Parent/subclaim original values and historical dates with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Parent/subclaim original values and historical dates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Subclaim score, status and axes are absent from the original. New corrections and external original-text comparisons were not performed. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Parent C50, B/P/R1/I1/E+/B2/CX, four false flags, empty override and subclaim C/note are preserved. Original bilingual wording, 2026-09-07, empty corrections array and empty deliberation string are not inherited as the current review date or a subclaim score.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subclaim score, status and axes are absent from the original. New corrections and external original-text comparisons were not performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Subclaim score, status and axes are absent from the original. New corrections and external original-text comparisons were not performed."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "Are historical checks the current reading?",
      "needed": "Historical review statements, summary use and external access",
      "role": "Required",
      "role_reason": "This condition connects Historical review statements, summary use and external access with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Historical review statements, summary use and external access must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Historical-check details, current external-original acquisition/reading and content review remain incomplete. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original primary-trial, ISRCTN and effect-size verification is preserved as historical wording. Stored summaries/bibliography were used here; original papers, registration, protocols, SAPs and COI remain unread without access attempts.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Historical-check details, current external-original acquisition/reading and content review remain incomplete.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Historical-check details, current external-original acquisition/reading and content review remain incomplete."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "Which materials would trigger an update?",
      "needed": "Linking summary reading, unread originals and needed material",
      "role": "Required",
      "role_reason": "This condition connects Linking summary reading, unread originals and needed material with selected daytime sleepiness in moderate OSA, the structured program/wait list, the same paper/registration, respondents, ESS versus other endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers, CIs, P values and study exposure only. Distinguish ESS points from AHI/h, PSQI and subjective bed-partner assessment; waiting from standard care; mean exposure from individual adherence; 25 completers from endpoint denominators; and the same paper/registration. Retrospective registration/historical checks do not become prerecruitment plans or current clinical review. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, playing/breathing methods, training, treatment-replacement or procedure instructions are created.",
      "criterion": "Material for Linking summary reading, unread originals and needed material must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: External-original acquisition, reading, URL verification and content review are needed. Complete pre-change originals, material/condition versions, separate application and change history must be retained. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original paper/ISRCTN URLs are retained and actual reading is distinguished as summary read versus external material unread. URL presence alone does not raise verification status.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "External-original acquisition, reading, URL verification and content review are needed. Complete pre-change originals, material/condition versions, separate application and change history must be retained.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "External-original acquisition, reading, URL verification and content review are needed. Complete pre-change originals, material/condition versions, separate application and change history must be retained."
    }
  ],
  "reports": [
    {
      "report_id": "S01",
      "title": "Puhan MA et al. BMJ 2006",
      "url": "https://pubmed.ncbi.nlm.nih.gov/16377643/",
      "report_type": "Randomized wait-list controlled trial",
      "existence": "The stored evidence/citation lists contain the original paper bibliography. External public availability and access status are unverified in this work.",
      "acquired_read": "Stored summaries read; original external papers, registration, protocols, SAPs and COI unread without access attempts",
      "study_family": "RG2991-PUHAN-ISRCTN31571714",
      "independent_replication": "The same paper/registration, 25 people, four months, multiple endpoints and two subclaim sheets are not counted as new independent trials, participants or replications. Confirmed unique-trial, participant and independent-replication totals are unrecorded; review of existing content remains incomplete.",
      "observed_result": "ESS −3.0 points (−5.7 to −0.3); AHI −6.2/h (−12.3 to −0.1); PSQI null",
      "result_level": "Preserved original-paper result summary. Selected ESS points are distinguished from AHI/h, PSQI and subjective bed-partner assessment. Arm denominators, exact models and prerecruitment plans are unverified; wait-list results are not transferred to replacement of standard therapy.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "External paper",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "Registration material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "Statistical analysis plan",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "Funding, product-support and COI material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 16377643, PMCID PMC1360393, DOI 10.1136/bmj.38705.470590.55 and same-trial ISRCTN31571714 link are preserved. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/16377643/"
        }
      ]
    },
    {
      "report_id": "S02",
      "title": "ISRCTN31571714. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome.",
      "url": "https://www.isrctn.com/ISRCTN31571714",
      "report_type": "Registration bibliography for the same trial; not a separate clinical-effect report",
      "existence": "The original citation list contains ISRCTN bibliography for the same trial. Presence of a registration URL is distinguished from current external reading or content verification.",
      "acquired_read": "Stored summaries read; original external papers, registration, protocols, SAPs and COI unread without access attempts",
      "study_family": "RG2991-PUHAN-ISRCTN31571714",
      "independent_replication": "The same paper/registration, 25 people, four months, multiple endpoints and two subclaim sheets are not counted as new independent trials, participants or replications. Confirmed unique-trial, participant and independent-replication totals are unrecorded; review of existing content remains incomplete.",
      "observed_result": "The original citation historically states that registration timing and multiple-endpoint descriptions were checked. This does not establish current registration reading or newly verified clinical effects.",
      "result_level": "Historical verification wording in preserved registration bibliography, linked to the same trial. The original statement that registration followed recruitment is retained. Exact recruitment/registration dates, change history, protocol and SAP remain unread; no separate effects, CIs or independent trials are created.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        },
        {
          "material_type": "External registration material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        },
        {
          "material_type": "Registration amendment history",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        },
        {
          "material_type": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        },
        {
          "material_type": "Statistical analysis plan",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        },
        {
          "material_type": "Funding, product-support and COI material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original ISRCTN31571714 URL is preserved. It registers the same Puhan 2006, 25-person four-month trial, not separate participants or an effect report. Original post-recruitment registration wording is distinguished from currently unread exact dates/plans."
        }
      ],
      "links": [
        {
          "label": "Official source",
          "url": "https://www.isrctn.com/ISRCTN31571714"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Preserved method HTML copies; no current method-content re-review or official tool execution"
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Preserved method HTML copies; no current method-content re-review or official tool execution"
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
      "section": "§8.1–8.2.3, Table 8.2.a",
      "official_principle": "Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.",
      "review_level": "Preserved method HTML copies; no current method-content re-review or official tool execution"
    },
    {
      "id": "M15",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15",
      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Preserved method HTML copies; no current method-content re-review or official tool execution"
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19",
      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Preserved method HTML copies; no current method-content re-review or official tool execution"
    }
  ],
  "status_dictionary": {
    "Met": "A state used when required evidence is confirmed after user review. This production does not declare that review complete.",
    "Partly verified": "Some information in the stored summary is linked into the table. External comparison/content review is not complete.",
    "Unverified": "The article leaves this unverified, or required material is absent from the current stored summary. This is distinct from zero, absence or safety.",
    "Review incomplete": "User review pending.",
    "Not reported": "Not reported within the stored material actually read; not extended to the entire primary paper.",
    "Inaccessible": "Means an actual access failure. Access not attempted here is not assigned this state.",
    "Not applicable": "Not used as a substitute for an evidence gap.",
    "Conflicting data": "Requires an observed disagreement under the same comparison criteria; not automatically judged in this production.",
    "Insufficient evidence for the conditions": "Marks a gap in additional material required by the selected conditions; not a new efficacy grade."
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "The S01 Puhan 2006 paper and S02 ISRCTN31571714 registration are preserved links to the same 25-person four-month didgeridoo lesson/home-practice versus wait-list trial. ESS, AHI, PSQI, bed-partner endpoints, two subclaim sheets and registration are not added as new independent trials, participants or replications. Detailed originals/registration remain externally unread; confirmed unique-trial, participant and independent-replication totals are unrecorded."
  },
  "history": [
    {
      "date": "2026-10-16",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "Public reader pages and material were prepared from the existing 28 items. No new clinical searches, verification-state changes or scoring were performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-16"
}