# Didgeridoo training × daytime sleepiness in moderate OSA

Verdict 2991 · Evidence Check

Stored-material review date: Not recorded  
Original evidence cut-off: 2026-09-07  
Review-criteria version: 1.0  
Public page/material preparation date: 2026-10-16

Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect.

## Assessment scope

- 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.
- Ingredient, formulation and route: 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.
- Measured outcome: 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.
- Questions outside this scope: 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

## Checklist items

### N01 · Which daytime-sleepiness claim is examined?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Separate subclaim score, status and axes are absent from the original. The selected claim and parent verdict must be distinguished.
- Required materials and conditions: Selected sleepiness claim, note/grade and parent verdict
- Materials to obtain first: Separate subclaim score, status and axes are absent from the original. The selected claim and parent verdict must be distinguished.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N02 · Which adults with moderate OSA were studied?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Exact age, sex, baseline ESS, diagnostic procedures and arm allocation denominators are unverified.
- Required materials and conditions: Eligibility, baseline characteristics, diagnosis and arm denominators
- Materials to obtain first: Exact age, sex, baseline ESS, diagnostic procedures and arm allocation denominators are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N03 · Which program was studied?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Lesson components, contact, individual actual practice and generalizable components are unverified.
- Required materials and conditions: Lessons, home practice, developer and intervention specification
- Materials to obtain first: Lesson components, contact, individual actual practice and generalizable components are unverified.
- Further research: Material needed: Lesson components, contact, individual actual practice and generalizable components are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N04 · Does average practice describe an individual procedure?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Planned exposure, individual distributions, discontinuation, adherence assessment and ESS by exposure are unverified.
- Required materials and conditions: Planned exposure, mean actual exposure, distribution and adherence
- Materials to obtain first: Planned exposure, individual distributions, discontinuation, adherence assessment and ESS by exposure are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N05 · What does the wait-list comparison establish?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Paper S01 is a randomized wait-list comparison. It is not a direct comparison with standard OSA therapy, another instrument or equal-contact sham.
- Why unverified: 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.
- Reason for missing information: Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified.
- Required materials and conditions: Control care, contact, expectations and concurrent treatment
- Materials to obtain first: Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified.
- Further research: Material needed: Detailed wait-list care, contact, expectation differences and concurrent treatment are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N06 · Are randomization and concealment detailed?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The S01 design and stored report record random allocation. The summary does not establish sequence generation, allocation concealment or processes before/after recruitment.
- Why unverified: 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.
- Reason for missing information: Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified.
- Required materials and conditions: Allocation sequence, concealment and recruitment processes
- Materials to obtain first: Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified.
- Further research: Material needed: Sequence generation, concealment, responsible staff and recruitment/allocation processes are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N07 · Is unblinded symptom assessment distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Assessor/analyst masking, contact/expectation differences and their control are unverified.
- Required materials and conditions: Participant, assessor/analyst masking and expectation differences
- Materials to obtain first: Assessor/analyst masking, contact/expectation differences and their control are unverified.
- Further research: Material needed: Assessor/analyst masking, contact/expectation differences and their control are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N08 · What did ESS assess and when?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The S01 main endpoint is the four-month Epworth Sleepiness Scale (ESS) score. AHI/h, PSQI and bed-partner disturbance are different measures.
- Why unverified: 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.
- Reason for missing information: Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified.
- Required materials and conditions: Scale, assessment window, method and units
- Materials to obtain first: Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified.
- Further research: Material needed: Scale administration, recall period, assessment timing, standardization and baseline distributions are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N09 · What is the original ESS difference, CI and P value?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Original arm values, exact analysis denominators, model, baseline adjustment and outcome-hierarchy details are unverified.
- Required materials and conditions: Comparative estimate, units, denominators and model
- Materials to obtain first: Original arm values, exact analysis denominators, model, baseline adjustment and outcome-hierarchy details are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N10 · Are ESS importance and individual distributions verified?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Prior relevance thresholds, individual distributions, response definitions and persistence are unverified.
- Required materials and conditions: Relevance thresholds, individual changes and uncertainty
- Materials to obtain first: Prior relevance thresholds, individual distributions, response definitions and persistence are unverified.
- Further research: Material needed: Prior relevance thresholds, individual distributions, response definitions and persistence are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N11 · Did effects persist after four months?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The original study assessed four months. Original statements that long-term complication prevention and standard-treatment replacement were not tested are preserved separately.
- Why unverified: 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.
- Reason for missing information: ESS persistence beyond four months, post-intervention changes and long-term clinical outcomes have no linked material.
- Required materials and conditions: Assessment duration, intervention cessation and long-term follow-up
- Materials to obtain first: ESS persistence beyond four months, post-intervention changes and long-term clinical outcomes have no linked material.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N12 · Is AHI a separate result from ESS?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Sleep-study methods, AHI calculation, condition-specific denominators and exact prior analysis plans are unverified.
- Required materials and conditions: Distinguishing ESS/AHI definitions, results and units
- Materials to obtain first: Sleep-study methods, AHI calculation, condition-specific denominators and exact prior analysis plans are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N13 · Is the null PSQI result also retained?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: PSQI procedures, denominators, model and prespecified hierarchy are unverified.
- Required materials and conditions: Endpoint-specific effects, units and uncertainty
- Materials to obtain first: PSQI procedures, denominators, model and prespecified hierarchy are unverified.
- Further research: Material needed: PSQI procedures, denominators, model and prespecified hierarchy are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N14 · Are the bed-partner respondent and endpoint distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Bed-partner denominators, scale, exact CIs/P values, masking and prior hierarchy are unverified.
- Required materials and conditions: Respondent, scale, endpoint and denominators
- Materials to obtain first: Bed-partner denominators, scale, exact CIs/P values, masking and prior hierarchy are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N15 · Does completion by everyone establish every analysis denominator?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Arm allocation, endpoint analysis denominators, missingness, ITT/PP and exclusion reasons are unverified.
- Required materials and conditions: Allocation, completion, endpoint analyses and missingness
- Materials to obtain first: Arm allocation, endpoint analysis denominators, missingness, ITT/PP and exclusion reasons are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N16 · Are concurrent treatment, weight and lifestyle changes verified?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified.
- Required materials and conditions: Arm-specific concurrent care, exposure and adjustment
- Materials to obtain first: Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified.
- Further research: Material needed: Concurrent therapy, weight/activity changes, medication, baseline adjustment and adherence are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N17 · When was ISRCTN registration made?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Exact recruitment/registration dates, original registration and change-history details remain unread.
- Required materials and conditions: Registration identity, recruitment/registration timing and original records
- Materials to obtain first: Exact recruitment/registration dates, original registration and change-history details remain unread.
- Further research: Material needed: Exact recruitment/registration dates, original registration and change-history details remain unread. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N18 · Does an ESS main endpoint establish the complete prior plan?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified.
- Required materials and conditions: Separating main-endpoint wording, registration, protocol and SAP
- Materials to obtain first: Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified.
- Further research: Material needed: Prerecruitment ESS hierarchy, protocol, SAP, change history and analysis plans are unverified. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N19 · Are multiple endpoints and test models distinguished?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Test direction, exact models, covariates, multiplicity and prior plans for additional endpoints are unverified.
- Required materials and conditions: All endpoints, tests, adjustment and multiplicity
- Materials to obtain first: Test direction, exact models, covariates, multiplicity and prior plans for additional endpoints are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N20 · Are the paper and registration separate trials?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Detailed original/registration plans and correspondence between analyses remain externally unread.
- Required materials and conditions: Reports, registration, trial family and population links
- Materials to obtain first: Detailed original/registration plans and correspondence between analyses remain externally unread.
- Further research: Material needed: Detailed original/registration plans and correspondence between analyses remain externally unread. This records needed materials; no new research was executed.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N21 · Was the sleepiness effect independently replicated?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Separate replication under the same conditions and actual trial-family independence are unverified.
- Required materials and conditions: Separate trials with the same population/intervention/comparator
- Materials to obtain first: Separate replication under the same conditions and actual trial-family independence are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N22 · Does this apply to other BMIs, severities or ages?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Population-specific ESS, AHI, safety and prior subgroup plans have no linked material.
- Required materials and conditions: Direct population-specific material and subgroup plans
- Materials to obtain first: Population-specific ESS, AHI, safety and prior subgroup plans have no linked material.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N23 · Do sleepiness/AHI signals establish replacement of standard therapy?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Direct standard-treatment comparisons, noninferiority and long-term clinical outcomes have no linked material.
- Required materials and conditions: Direct standard-treatment comparisons and clinical outcomes
- Materials to obtain first: Direct standard-treatment comparisons, noninferiority and long-term clinical outcomes have no linked material.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N24 · Are funding, the developer-instructor and conflicts distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Funding roles, equipment/instrument support, developer-instructor roles, employee authors, COI and analysis/reporting involvement are unverified.
- Required materials and conditions: Original support, product, employee/developer and COI records
- Materials to obtain first: Funding roles, equipment/instrument support, developer-instructor roles, employee authors, COI and analysis/reporting involvement are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N25 · What was reported about safety and sample-size limits?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Collection methods, event definitions, arm denominators, rare/long-term harms and treatment-cessation material are unverified.
- Required materials and conditions: Harm collection, exposure, arm denominators and follow-up
- Materials to obtain first: Collection methods, event definitions, arm denominators, rare/long-term harms and treatment-cessation material are unverified.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01

### N26 · Are parent values, subclaim grade and the evidence date separated?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Subclaim score, status and axes are absent from the original. New corrections and external original-text comparisons were not performed.
- Required materials and conditions: Parent/subclaim original values and historical dates
- Materials to obtain first: Subclaim score, status and axes are absent from the original. New corrections and external original-text comparisons were not performed.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N27 · Are historical checks the current reading?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Historical-check details, current external-original acquisition/reading and content review remain incomplete.
- Required materials and conditions: Historical review statements, summary use and external access
- Materials to obtain first: Historical-check details, current external-original acquisition/reading and content review remain incomplete.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

### N28 · Which materials would trigger an update?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Linking summary reading, unread originals and needed material
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: S01, S02

## Evidence and sources

### S01

Puhan MA et al. BMJ 2006

[PubMed](https://pubmed.ncbi.nlm.nih.gov/16377643/)

Materials actually read: Stored summaries read; original external papers, registration, protocols, SAPs and COI unread without access attempts  
Findings recorded in the summary: ESS −3.0 points (−5.7 to −0.3); AHI −6.2/h (−12.3 to −0.1); PSQI null  
Record 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.  
Independent replication: 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.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | 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. |
| External paper | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Protocol | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Statistical analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Funding, product-support and COI material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |

### S02

ISRCTN31571714. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome.

[Official source](https://www.isrctn.com/ISRCTN31571714)

Materials actually read: Stored summaries read; original external papers, registration, protocols, SAPs and COI unread without access attempts  
Findings recorded in the summary: 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.  
Record 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.  
Independent replication: 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.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | 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. |
| External registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Registration amendment history | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Protocol | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Statistical analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| Funding, product-support and COI material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |

## Review criteria and methods

These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score.

- M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Preserved method HTML copies; no current method-content re-review or official tool execution
- M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Preserved method HTML copies; no current method-content re-review or official tool execution
- M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Preserved method HTML copies; no current method-content re-review or official tool execution
- M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Preserved method HTML copies; no current method-content re-review or official tool execution
- M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Preserved method HTML copies; no current method-content re-review or official tool execution

## What the statuses mean

- 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.

## Change history

2026-10-16 · Public page/materials 1.0. Public reader pages and material were prepared from the existing 28 items. No new clinical searches, verification-state changes or scoring were performed.