{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2992-s0",
  "verdict_number": "2992",
  "title": "Multicomponent oropharyngeal exercise × AHI and symptoms",
  "view_version": "1.0",
  "view_created_date": "2026-10-16",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "Distinguish 31 people with moderate OSA in the Guimarães multicomponent trial, 27 in Poncin tongue elevation and 20 with mild-to-moderate sleep-disordered breathing in Yoshioka. Detailed eligibility, arm allocation, endpoint denominators, baseline therapy and the impact of completer analysis are unverified. Participants are not added together or effects generalized to all snoring/sleep disorders.",
    "intervention": "Multicomponent oropharyngeal myofunctional programs, isolated tongue elevation and device-based tongue resistance are different interventions. Differences in muscles, components, supervision, tools and adherence are retained. Package effects are not assigned to one component; no new oral/breathing-training methods are given.",
    "dose": "Durations of three months for the multicomponent program, six weeks for tongue elevation and eight weeks for device-based tongue resistance identify the studies. Intensity, actual adherence, repetitions and concurrent care details are unverified. Total amounts, frequency and individual intensity are not newly converted or turned into training prescriptions.",
    "comparator": "Distinguish control exercise in the multicomponent trial, sham in Poncin and no intervention in Yoshioka. Contact, expectations, masking, concurrent standard therapy and actual contrasts are unverified. Different controls are not pooled as the same comparison.",
    "endpoint": "The selected question is AHI/symptom benefit from multicomponent programs, with original subclaim grade C. Guimarães exercise-group within-group AHI 22.4±4.8 to 13.7±8.5/h is distinguished from unavailable exact between-group change and 95% CI. Poncin primary AHI null/secondary ESS signals and Yoshioka AHI P=.44/ESS P=.62 concern separate tongue training. The meaning of ±, exact comparative effects and endpoint denominators are unverified.",
    "duration": "Retain report-specific durations of three months for the multicomponent program, six weeks for tongue elevation and eight weeks for device-based tongue resistance. Direct evidence on post-intervention AHI/symptom persistence, long-term clinical events, rare harms and standard-treatment replacement is unverified.",
    "excluded_extensions": [
      "Transferring multicomponent within-group AHI/symptom signals into exact comparative effects, one-component effects or primary success for tongue-only training",
      "Converting null P values into zero effect, equivalence or null effects for every program, or secondary ESS/tongue strength/app snoring into AHI success",
      "Using combined summaries, reports, two subclaim sheets or repeated measurements as unique-trial/participant totals or independent replication",
      "Inheriting historical checks of five RCTs or registration identifiers as current external reading, prerecruitment plans or new independence certification",
      "Filling subclaim scores/status with parent C46, Caution or axes, or assigning device support or one oral-abrasion participant to a specific tongue report without support",
      "Creating new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "What is the original grade for the selected multicomponent-program claim?",
      "needed": "Multicomponent oropharyngeal AHI/symptom claim, note and parent context",
      "role": "Required",
      "role_reason": "This condition connects Multicomponent oropharyngeal AHI/symptom claim, note and parent context with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Multicomponent oropharyngeal AHI/symptom claim, note and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Details of components, population, comparator, direct AHI/symptom material and claim boundaries are unverified. Parent scores do not fill subclaim scores. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The selected original subclaim is AHI and symptom benefit from multicomponent programs, with grade C and note 'Favorable signals have limited comparative quantification and replication.' Subclaim score, status and axes are absent; distinguish parent C46 and the separate tongue-only D.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Details of components, population, comparator, direct AHI/symptom material and claim boundaries are unverified. Parent scores do not fill subclaim scores.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Details of components, population, comparator, direct AHI/symptom material and claim boundaries are unverified. Parent scores do not fill subclaim scores."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Are the key AHI values within-group changes?",
      "needed": "Guimarães exercise-group AHI versus comparative estimands",
      "role": "Required",
      "role_reason": "This condition connects Guimarães exercise-group AHI versus comparative estimands with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Guimarães exercise-group AHI versus comparative estimands must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original control values, direct/adjusted between-group estimates, CIs, denominators, models and the meaning of ± are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "In the 31-person multicomponent trial, exercise-group AHI was 22.4±4.8 to 13.7±8.5/h. The original records within-exercise-group means and an unrecovered exact between-group change and 95% CI. No new change or reduction percentage is calculated or converted into a between-group effect.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original control values, direct/adjusted between-group estimates, CIs, denominators, models and the meaning of ± are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original control values, direct/adjusted between-group estimates, CIs, denominators, models and the meaning of ± are unverified."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "How specific are multicomponent symptom signals?",
      "needed": "Separate AHI, ESS, sleepiness and snoring outcomes",
      "role": "Required",
      "role_reason": "This condition connects Separate AHI, ESS, sleepiness and snoring outcomes with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Separate AHI, ESS, sleepiness and snoring outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Each symptom scale, time, denominator, comparator, effect, CI and prior hierarchy is needed. Symptom signals are not combined with AHI success. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original Guimarães citation records multicomponent AHI/ESS signals, and the parent describes symptom signals in multicomponent/snoring trials. Individual ESS/symptom comparative effects, CIs, exact P values and snoring measurement details are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Each symptom scale, time, denominator, comparator, effect, CI and prior hierarchy is needed. Symptom signals are not combined with AHI success.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Each symptom scale, time, denominator, comparator, effect, CI and prior hierarchy is needed. Symptom signals are not combined with AHI success."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Are multicomponent and tongue-only interventions the same?",
      "needed": "Muscles, components, supervision, tools and adherence",
      "role": "Required",
      "role_reason": "This condition connects Muscles, components, supervision, tools and adherence with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Muscles, components, supervision, tools and adherence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Program components, original methods, comparators, actual exposure and component-specific contribution material are needed. No new oral/breathing-training methods are provided. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original states that muscles, components, supervision, tools and adherence define different interventions and multicomponent results cannot be transferred to one tongue exercise. Contributions of individual components are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Program components, original methods, comparators, actual exposure and component-specific contribution material are needed. No new oral/breathing-training methods are provided.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Program components, original methods, comparators, actual exposure and component-specific contribution material are needed. No new oral/breathing-training methods are provided."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "Which programs lasted three months, six weeks and eight weeks?",
      "needed": "Separate multicomponent, tongue-elevation and device-resistance durations",
      "role": "Required",
      "role_reason": "This condition connects Separate multicomponent, tongue-elevation and device-resistance durations with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Separate multicomponent, tongue-elevation and device-resistance durations must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific duration, intensity, actual adherence, tools, post-intervention follow-up and condition-specific denominators are unverified. Duration identifies studies, not training or treatment-replacement instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original separates a three-month multicomponent trial with 31 people, a six-week sham-controlled tongue-elevation trial with 27 and an eight-week device-based tongue-resistance trial with 20 and no-intervention control. Three months is not copied to every program.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific duration, intensity, actual adherence, tools, post-intervention follow-up and condition-specific denominators are unverified. Duration identifies studies, not training or treatment-replacement instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific duration, intensity, actual adherence, tools, post-intervention follow-up and condition-specific denominators are unverified. Duration identifies studies, not training or treatment-replacement instructions."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Do actual comparators also differ by program?",
      "needed": "Control exercise, sham and no intervention",
      "role": "Required",
      "role_reason": "This condition connects Control exercise, sham and no intervention with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Control exercise, sham and no intervention must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific control components, concurrent standard therapy, adherence, masking, attention differences and actual comparison details are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Distinguish control exercise in the multicomponent trial, sham in six-week tongue elevation and no intervention in eight-week device-based tongue resistance. Multicomponent control exercise is not copied to every tongue trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific control components, concurrent standard therapy, adherence, masking, attention differences and actual comparison details are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific control components, concurrent standard therapy, adherence, masking, attention differences and actual comparison details are unverified."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "What was Poncin's primary AHI result?",
      "needed": "Direct AHI in the sham-controlled tongue-elevation trial",
      "role": "Required",
      "role_reason": "This condition connects Direct AHI in the sham-controlled tongue-elevation trial with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Direct AHI in the sham-controlled tongue-elevation trial must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The original primary AHI analysis table, arm denominators, effects, CIs, P values, prior plans and sham components are needed. Null results do not establish zero effect or equivalence. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Poncin 2022 is recorded as a null between-group primary AHI result for tongue-only training. It is not overwritten by the favorable within-group direction in multicomponent Guimarães; exact effects, CIs and P values remain unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The original primary AHI analysis table, arm denominators, effects, CIs, P values, prior plans and sham components are needed. Null results do not establish zero effect or equivalence.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The original primary AHI analysis table, arm denominators, effects, CIs, P values, prior plans and sham components are needed. Null results do not establish zero effect or equivalence."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Do Poncin ESS and tongue endurance establish primary success?",
      "needed": "Failed primary AHI versus secondary symptoms/function",
      "role": "Required",
      "role_reason": "This condition connects Failed primary AHI versus secondary symptoms/function with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Failed primary AHI versus secondary symptoms/function must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Secondary ESS/endurance values, denominators, P values, CIs, prior hierarchy, multiplicity and exact report attribution of endurance wording are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original citation records Poncin primary AHI null and secondary ESS positive. Positive ESS/tongue-endurance wording in the original is secondary to failed primary AHI, not multicomponent AHI effects or primary success.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Secondary ESS/endurance values, denominators, P values, CIs, prior hierarchy, multiplicity and exact report attribution of endurance wording are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Secondary ESS/endurance values, denominators, P values, CIs, prior hierarchy, multiplicity and exact report attribution of endurance wording are unverified."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What were Yoshioka AHI and ESS results?",
      "needed": "Endpoint-specific device-based tongue-resistance results",
      "role": "Required",
      "role_reason": "This condition connects Endpoint-specific device-based tongue-resistance results with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Endpoint-specific device-based tongue-resistance results must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original endpoint values, comparative effects, CIs, denominators, missingness and prior hierarchy are unverified. P values do not produce regrading as zero effect or equivalence. This records needed materials; no new research was executed.",
      "current_reports": [
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Yoshioka 2024 records AHI P=.44 and ESS P=.62. Poncin secondary ESS positivity is not copied to Yoshioka ESS. The original boundaries of 20 participants and completer analysis are retained.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original endpoint values, comparative effects, CIs, denominators, missingness and prior hierarchy are unverified. P values do not produce regrading as zero effect or equivalence.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original endpoint values, comparative effects, CIs, denominators, missingness and prior hierarchy are unverified. P values do not produce regrading as zero effect or equivalence."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "How should the combined tongue-trial summary be separated?",
      "needed": "Combined Poncin/Yoshioka summary versus individual bibliography",
      "role": "Required",
      "role_reason": "This condition connects Combined Poncin/Yoshioka summary versus individual bibliography with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Combined Poncin/Yoshioka summary versus individual bibliography must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific mapping of participants, comparator, duration, funding, endpoints and results is needed. Bibliography counts do not certify independence or unique-participant totals. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original tongue-evidence row combines Poncin 2022, Yoshioka 2024, 27 and 20 participants and two null AHI results; original citations identify separate reports. Combined participant/results information is not copied as each individual report's values.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific mapping of participants, comparator, duration, funding, endpoints and results is needed. Bibliography counts do not certify independence or unique-participant totals.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific mapping of participants, comparator, duration, funding, endpoints and results is needed. Bibliography counts do not certify independence or unique-participant totals."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Are multicomponent and tongue-only populations the same?",
      "needed": "Moderate OSA, mild-to-moderate sleep-disordered breathing and snoring",
      "role": "Required",
      "role_reason": "This condition connects Moderate OSA, mild-to-moderate sleep-disordered breathing and snoring with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Moderate OSA, mild-to-moderate sleep-disordered breathing and snoring must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Baseline AHI, diagnosis, severity, snoring-only eligibility, BMI, medicines, standard therapy, exclusions and arm baseline values are unverified. Effects are not extended equally to every sleep disorder. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Guimarães bibliography concerns moderate OSA; Yoshioka concerns mild-to-moderate sleep-disordered breathing. Distinguish broad parent adult snoring/OSA context from each report's eligibility, severity and baseline therapy.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Baseline AHI, diagnosis, severity, snoring-only eligibility, BMI, medicines, standard therapy, exclusions and arm baseline values are unverified. Effects are not extended equally to every sleep disorder.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Baseline AHI, diagnosis, severity, snoring-only eligibility, BMI, medicines, standard therapy, exclusions and arm baseline values are unverified. Effects are not extended equally to every sleep disorder."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Are AHI, app snoring, sleepiness and tongue strength the same measure?",
      "needed": "Objective apnea, symptoms and function",
      "role": "Required",
      "role_reason": "This condition connects Objective apnea, symptoms and function with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Objective apnea, symptoms and function must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: AHI measurement, scoring and valid sleep time, ESS/snoring/tongue-function scales and their denominators, times and CIs are needed. No new diagnosis, training or replacement instructions are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original does not convert sleepiness, snoring or tongue strength into AHI success, or accept 'reduced app snoring = reduced AHI'. Symptom signals are separate from OSA severity and treatment need.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "AHI measurement, scoring and valid sleep time, ESS/snoring/tongue-function scales and their denominators, times and CIs are needed. No new diagnosis, training or replacement instructions are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "AHI measurement, scoring and valid sleep time, ESS/snoring/tongue-function scales and their denominators, times and CIs are needed. No new diagnosis, training or replacement instructions are created."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Are registered primary outcomes distinguished from retrospective registration?",
      "needed": "Report-specific registration identifiers, dates, changes and prior plans",
      "role": "Required",
      "role_reason": "This condition connects Report-specific registration identifiers, dates, changes and prior plans with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Report-specific registration identifiers, dates, changes and prior plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Initial/changed registration dates, protocols, SAPs, start dates, primary/secondary outcomes and analysis plans are needed. A registration number alone does not certify preregistration. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original Guimarães evidence row records registered primary AHI, while its citation records retrospective registration. NCT00660777, NCT03846349 and UMIN000041489 are original citation identifiers; actual dates, changes and prior planning remain unread.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Initial/changed registration dates, protocols, SAPs, start dates, primary/secondary outcomes and analysis plans are needed. A registration number alone does not certify preregistration.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Initial/changed registration dates, protocols, SAPs, start dates, primary/secondary outcomes and analysis plans are needed. A registration number alone does not certify preregistration."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Are original participant counts, completers and analysis denominators known?",
      "needed": "31, 27 and 20 participants versus analysis flow",
      "role": "Required",
      "role_reason": "This condition connects 31, 27 and 20 participants versus analysis flow with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for 31, 27 and 20 participants versus analysis flow must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Arm allocation/analysis flow, exclusion reasons, endpoint-specific missingness and actual exposure are needed. Repeated observations of one participant are not added as new people. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records key samples of 31, 27 and 20; the Yoshioka citation marks completer analysis. Arm allocation, completion, valid endpoint denominators and missing-data handling are unverified. Participants, losses and percentages are not newly calculated.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Arm allocation/analysis flow, exclusion reasons, endpoint-specific missingness and actual exposure are needed. Repeated observations of one participant are not added as new people.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm allocation/analysis flow, exclusion reasons, endpoint-specific missingness and actual exposure are needed. Repeated observations of one participant are not added as new people."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are historical checks of five RCTs the same as the current report count?",
      "needed": "Historical study count, identified reports and unidentified reports",
      "role": "Required",
      "role_reason": "This condition connects Historical study count, identified reports and unidentified reports with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Historical study count, identified reports and unidentified reports must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Mapping the historical five to original reports, cohorts and endpoints is needed. New R04/R05 reports, effects, denominators or confirmed independent-trial counts are not invented to fill gaps. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent historically describes checks of five RCTs, registries and primary outcomes, while current evidence has two rows with two tongue trials combined in one row and three citations. Other multicomponent/snoring reports are not all separately identified by bibliography.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Mapping the historical five to original reports, cohorts and endpoints is needed. New R04/R05 reports, effects, denominators or confirmed independent-trial counts are not invented to fill gaps.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Mapping the historical five to original reports, cohorts and endpoints is needed. New R04/R05 reports, effects, denominators or confirmed independent-trial counts are not invented to fill gaps."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Does between-program conflict establish blanket benefit or blanket null effects?",
      "needed": "Component-specific directness, comparators and replication",
      "role": "Required",
      "role_reason": "This condition connects Component-specific directness, comparators and replication with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Component-specific directness, comparators and replication must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Separate direct material with the same components, comparators, populations and prior endpoints, plus effects/CIs, is needed. Parent R0/EX are original values, not new independent-replication certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original states that component differences precluded blanket E+ or blanket null conclusions. Repeated tongue-only primary failures are not transferred into multicomponent null effects, or multicomponent symptom signals into tongue-only success.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Separate direct material with the same components, comparators, populations and prior endpoints, plus effects/CIs, is needed. Parent R0/EX are original values, not new independent-replication certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Separate direct material with the same components, comparators, populations and prior endpoints, plus effects/CIs, is needed. Parent R0/EX are original values, not new independent-replication certification."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Are exact comparative magnitudes, CIs and clinical importance available?",
      "needed": "AHI/symptom-specific estimands and precision",
      "role": "Required",
      "role_reason": "This condition connects AHI/symptom-specific estimands and precision with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for AHI/symptom-specific estimands and precision must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report/endpoint-specific comparative estimands, models, denominators, CIs and prior importance criteria are needed. ± is not converted into a CI; no new effects or hypothetical examples are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Distinguish multicomponent exercise-group AHI values from unavailable exact between-group change and 95% CI. Symptom signals and tongue-only P values are different values; their CIs and clinical importance are also unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report/endpoint-specific comparative estimands, models, denominators, CIs and prior importance criteria are needed. ± is not converted into a CI; no new effects or hypothetical examples are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report/endpoint-specific comparative estimands, models, denominators, CIs and prior importance criteria are needed. ± is not converted into a CI; no new effects or hypothetical examples are created."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Are there post-training or standard-treatment-replacement results?",
      "needed": "Persistence and long-term clinical outcomes by duration",
      "role": "Required",
      "role_reason": "This condition connects Persistence and long-term clinical outcomes by duration with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Persistence and long-term clinical outcomes by duration must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Post-intervention follow-up, the same components/comparators, concurrent standard therapy and direct clinical results/CIs are needed. No oral/breathing training, replacement or procedure instructions are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original three-month, six-week and eight-week durations concern different programs. Post-intervention AHI/symptom persistence, long-term clinical harms/complications and direct replacement results are not established from this stored material.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Post-intervention follow-up, the same components/comparators, concurrent standard therapy and direct clinical results/CIs are needed. No oral/breathing training, replacement or procedure instructions are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Post-intervention follow-up, the same components/comparators, concurrent standard therapy and direct clinical results/CIs are needed. No oral/breathing training, replacement or procedure instructions are created."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Are shared reports distinguished from independence?",
      "needed": "Parent, two subclaim sheets, reports and population relationships",
      "role": "Required",
      "role_reason": "This condition connects Parent, two subclaim sheets, reports and population relationships with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Parent, two subclaim sheets, reports and population relationships must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific cohorts, duration, analysis populations and shared relationships are needed. Different bibliographies are distinguished from independent-replication certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Parent 2992 and original subclaim sheets share the same stored report context. Reports, sheets and repeated measurements are not added as new independent trials or participants; unique-trial and participant totals are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific cohorts, duration, analysis populations and shared relationships are needed. Different bibliographies are distinguished from independent-replication certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific cohorts, duration, analysis populations and shared relationships are needed. Different bibliographies are distinguished from independent-replication certification."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Which materials were actually read?",
      "needed": "Complete stored summary versus external originals",
      "role": "Required",
      "role_reason": "This condition connects Complete stored summary versus external originals with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Complete stored summary versus external originals must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual papers, appendices, registration, plans and reading records are needed. No new external clinical lookup, reading or content review was performed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The complete parent stored summary was used and an original copy preserved. External abstracts, full texts, registration, protocols and SAPs remain unread. URLs/numbers alone do not raise reading, public-access or condition-fulfillment status.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual papers, appendices, registration, plans and reading records are needed. No new external clinical lookup, reading or content review was performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual papers, appendices, registration, plans and reading records are needed. No new external clinical lookup, reading or content review was performed."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Are original Korean/English wording and historical checks distinguished?",
      "needed": "Original claims/notes and historical verification scope",
      "role": "Required",
      "role_reason": "This condition connects Original claims/notes and historical verification scope with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Original claims/notes and historical verification scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Detailed comparison of originals, translation, corrections and claim boundaries, plus review of existing content, remains incomplete. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original Korean/English wording, subclaims/notes and historical checking statements in the parent/citations are preserved. Current summary use does not become new verification of originals, tables, registration or abstracts, or independent clinical certification.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed comparison of originals, translation, corrections and claim boundaries, plus review of existing content, remains incomplete.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed comparison of originals, translation, corrections and claim boundaries, plus review of existing content, remains incomplete."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are subclaim values distinguished from parent scores and axes?",
      "needed": "Subclaim C/note versus parent C46, safety and axes",
      "role": "Required",
      "role_reason": "This condition connects Subclaim C/note versus parent C46, safety and axes with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Subclaim C/note versus parent C46, safety and axes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Subclaim score, status and axes are absent from the original. No new scores, axes, grades or efficacy reassessment were performed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original subclaim C/note and absent score, status and axes are retained. Parent C46, Caution, B/S/R0/I1/EX/B2/CX, three false flags, primary-failed-secondary-positive true and empty override are parent context, not filled into subclaim values.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subclaim score, status and axes are absent from the original. No new scores, axes, grades or efficacy reassessment were performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Subclaim score, status and axes are absent from the original. No new scores, axes, grades or efficacy reassessment were performed."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Are evidence dates and corrections distinguished from production dates?",
      "needed": "Original date, empty corrections/deliberation and production",
      "role": "Required",
      "role_reason": "This condition connects Original date, empty corrections/deliberation and production with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Original date, empty corrections/deliberation and production must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: New corrections, follow-up material and complete pre-change history are needed. Original dates and empty values are not arbitrarily filled. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Retain original 2026-09-07, an empty corrections array and empty deliberation string. They do not become the current review date or certification that no external corrections exist.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "New corrections, follow-up material and complete pre-change history are needed. Original dates and empty values are not arbitrarily filled.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "New corrections, follow-up material and complete pre-change history are needed. Original dates and empty values are not arbitrarily filled."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are bibliography/registration identities distinguished from actual access?",
      "needed": "Presence/absence of PMID, DOI, PMCID and registration identifiers",
      "role": "Required",
      "role_reason": "This condition connects Presence/absence of PMID, DOI, PMCID and registration identifiers with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Presence/absence of PMID, DOI, PMCID and registration identifiers must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report/registration/full-text identity, date and content links are needed. Numbers alone do not certify actual reading, prior planning or accessibility. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original citation PMID/DOI/PMCID/NCT/UMIN presence or absence is preserved per report, with original PubMed URLs only. Full-text or registration URLs are not newly inferred from identifiers.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report/registration/full-text identity, date and content links are needed. Numbers alone do not certify actual reading, prior planning or accessibility.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report/registration/full-text identity, date and content links are needed. Numbers alone do not certify actual reading, prior planning or accessibility."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "Are funding, products, employee authors and analysis/reporting roles distinguished?",
      "needed": "Four report-specific support/interest areas",
      "role": "Required",
      "role_reason": "This condition connects Four report-specific support/interest areas with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Four report-specific support/interest areas must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original report-specific funding, COI, product/device support, employee affiliations and analysis/publication roles are unverified. Parent independence axes are not used as new certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Guimarães funding is incompletely verified; the combined tongue summary records public/university support and a device supplied in one trial. The combined row alone does not identify which tongue trial received the device. Product support, employee authors and analysis/reporting involvement remain separate.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original report-specific funding, COI, product/device support, employee affiliations and analysis/publication roles are unverified. Parent independence axes are not used as new certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original report-specific funding, COI, product/device support, employee affiliations and analysis/publication roles are unverified. Parent independence axes are not used as new certification."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Are allocation, measurement and selective-reporting bias details available?",
      "needed": "Report-specific design, masking and denominators",
      "role": "Required",
      "role_reason": "This condition connects Report-specific design, masking and denominators with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Report-specific design, masking and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Methods, registration, protocols, SAPs, measurement originals, denominators and change history are needed. Design labels alone do not establish official RoB/GRADE or passed review. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Retain original multicomponent/tongue randomized designs and primary/secondary distinctions. Allocation concealment, measurement/scoring, components, controls, missingness and selective-reporting details are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Methods, registration, protocols, SAPs, measurement originals, denominators and change history are needed. Design labels alone do not establish official RoB/GRADE or passed review.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Methods, registration, protocols, SAPs, measurement originals, denominators and change history are needed. Design labels alone do not establish official RoB/GRADE or passed review."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "Are actual exposure, adherence and concurrent care known?",
      "needed": "Study exposure, adherence and cointerventions",
      "role": "Required",
      "role_reason": "This condition connects Study exposure, adherence and cointerventions with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Study exposure, adherence and cointerventions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific actual exposure, adherence, intervention departures, concurrent care and denominators are needed. Total amounts/repetitions are not newly calculated; no oral/breathing-training methods are given. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Muscles, components, supervision, tools and duration identify studies. Actual adherence, concurrent standard therapy, weight/other-exercise changes and analysis-population details are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific actual exposure, adherence, intervention departures, concurrent care and denominators are needed. Total amounts/repetitions are not newly calculated; no oral/breathing-training methods are given.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific actual exposure, adherence, intervention departures, concurrent care and denominators are needed. Total amounts/repetitions are not newly calculated; no oral/breathing-training methods are given."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "Is the oral-abrasion narrative distinguished from harm denominators?",
      "needed": "Adverse event, report attribution, exposure, comparator and denominators",
      "role": "Supplementary",
      "role_reason": "This condition connects Adverse event, report attribution, exposure, comparator and denominators with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Adverse event, report attribution, exposure, comparator and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific harm definitions, collection, exposure, denominators, departures, controls, severity and original-report links are needed. Original safety values do not become no-harm findings or new safety certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original safety wording records one exercise-arm participant in a tongue-training trial temporarily stopping because of an oral mucosal abrasion, then resuming. Exact report, arm denominators, exposure and collection systems are not established by this wording and are not arbitrarily assigned to a specific tongue report.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific harm definitions, collection, exposure, denominators, departures, controls, severity and original-report links are needed. Original safety values do not become no-harm findings or new safety certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific harm definitions, collection, exposure, denominators, departures, controls, severity and original-report links are needed. Original safety values do not become no-harm findings or new safety certification."
    },
    {
      "item_id": "N29",
      "question_type": "Evidence condition",
      "question": "Can results extend to long-term/rare harms and clinical outcomes?",
      "needed": "Selected populations, short duration and long-term/rare harms",
      "role": "Supplementary",
      "role_reason": "This condition connects Selected populations, short duration and long-term/rare harms with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Selected populations, short duration and long-term/rare harms must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Long-term follow-up, populations, exposure, harm surveillance, endpoint denominators and CIs are needed. No new oral/breathing training, standard-treatment replacement or treatment instructions are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Retain the original boundary that sleepiness/snoring changes alone cannot determine OSA severity or treatment need. Direct evidence for long-term/rare harms and standard-treatment replacement is unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Long-term follow-up, populations, exposure, harm surveillance, endpoint denominators and CIs are needed. No new oral/breathing training, standard-treatment replacement or treatment instructions are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Long-term follow-up, populations, exposure, harm surveillance, endpoint denominators and CIs are needed. No new oral/breathing training, standard-treatment replacement or treatment instructions are created."
    },
    {
      "item_id": "N30",
      "question_type": "Evidence condition",
      "question": "Which materials would trigger an update?",
      "needed": "Original material, conditions, observations and change events",
      "role": "Required",
      "role_reason": "This condition connects Original material, conditions, observations and change events with AHI/symptoms from multicomponent oropharyngeal programs, separate tongue training, and report-specific populations, comparators, durations, within/between-group results, denominators and harms.",
      "application_exception": "Preserve original numbers, P values and study exposure only. Distinguish multicomponent from tongue-only programs, within-group changes from between-group estimates, primary AHI from secondary ESS/function, and each comparator, duration, denominator and combined summary. Retrospective registration/historical checks do not become current reading or certification of prior plans. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, oral/breathing training, standard-treatment replacement or procedure instructions are created.",
      "criterion": "Material for Original material, conditions, observations and change events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Complete pre-change originals, material/condition versions, separate applications and change history are needed. No new clinical searching, calculations, grades, independence certification or training/treatment methods were performed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Needed material is distinguished using the stored multicomponent oropharyngeal AHI/symptom summary. Relevant observations can be updated when original result tables, registration, plans, report mapping, endpoints, times, comparative effects, denominators, support and harms become available.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Complete pre-change originals, material/condition versions, separate applications and change history are needed. No new clinical searching, calculations, grades, independence certification or training/treatment methods were performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Complete pre-change originals, material/condition versions, separate applications and change history are needed. No new clinical searching, calculations, grades, independence certification or training/treatment methods were performed."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Guimarães KC et al. 2009",
      "url": "https://pubmed.ncbi.nlm.nih.gov/19234106/",
      "report_type": "Randomized multicomponent oropharyngeal exercise trial",
      "existence": "Bibliography is present in the original stored citation list. External public availability and access status are unverified in this work.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread without access attempts",
      "study_family": "F01",
      "independent_replication": "The original parent and two subclaim sheets share the same report context. Bibliography, a combined row, repeated measurements and historical checks of five RCTs are not counted as new unique trials, participants or independent replications. Confirmed totals are unrecorded and review of existing content remains incomplete.",
      "observed_result": "Within-exercise-group AHI 22.4±4.8 to 13.7±8.5/h; exact between-group change/CI unverified",
      "result_level": "Original evidence row for the 31-person three-month multicomponent trial, with within-group values. The original citation describes AHI/ESS signals and retrospective registration. Exact between-group effects, 95% CI, denominators and the meaning of ± are unverified; registered primary AHI does not establish verified prerecruitment plans.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Existing stored review summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "The original PubMed URL and PMID 19234106, DOI 10.1164/rccm.200806-981OC, NCT00660777 and unrecorded PMCID are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 19234106, DOI 10.1164/rccm.200806-981OC, NCT00660777 and unrecorded PMCID are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "fulltext",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 19234106, DOI 10.1164/rccm.200806-981OC, NCT00660777 and unrecorded PMCID are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "registration",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 19234106, DOI 10.1164/rccm.200806-981OC, NCT00660777 and unrecorded PMCID are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 19234106, DOI 10.1164/rccm.200806-981OC, NCT00660777 and unrecorded PMCID are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/19234106/"
        }
      ]
    },
    {
      "report_id": "R02",
      "title": "Poncin W et al. 2022",
      "url": "https://pubmed.ncbi.nlm.nih.gov/36081312/",
      "report_type": "Sham-controlled randomized tongue-elevation trial; separate from the multicomponent program",
      "existence": "Bibliography is present in the original stored citation list. External public availability and access status are unverified in this work.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread without access attempts",
      "study_family": "F02",
      "independent_replication": "The original parent and two subclaim sheets share the same report context. Bibliography, a combined row, repeated measurements and historical checks of five RCTs are not counted as new unique trials, participants or independent replications. Confirmed totals are unrecorded and review of existing content remains incomplete.",
      "observed_result": "Tongue-only primary AHI null and secondary ESS positive; exact effects, CIs and P values unverified",
      "result_level": "The original combined summary records Poncin 27 and Yoshioka 20 together. Poncin six-week sham comparison, primary AHI null and secondary ESS signal are linked separately; arm denominators, exact effects, CIs, P values and report-specific attribution of tongue endurance are unverified.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Existing stored review summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "The original PubMed URL and PMID 36081312, PMCID PMC9826101, DOI 10.1111/joor.13369 and NCT03846349 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 36081312, PMCID PMC9826101, DOI 10.1111/joor.13369 and NCT03846349 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "fulltext",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 36081312, PMCID PMC9826101, DOI 10.1111/joor.13369 and NCT03846349 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "registration",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 36081312, PMCID PMC9826101, DOI 10.1111/joor.13369 and NCT03846349 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 36081312, PMCID PMC9826101, DOI 10.1111/joor.13369 and NCT03846349 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/36081312/"
        }
      ]
    },
    {
      "report_id": "R03",
      "title": "Yoshioka J et al. 2024",
      "url": "https://pubmed.ncbi.nlm.nih.gov/38529043/",
      "report_type": "Randomized device-based tongue-resistance trial with no-intervention control; separate from the multicomponent program",
      "existence": "Bibliography is present in the original stored citation list. External public availability and access status are unverified in this work.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread without access attempts",
      "study_family": "F03",
      "independent_replication": "The original parent and two subclaim sheets share the same report context. Bibliography, a combined row, repeated measurements and historical checks of five RCTs are not counted as new unique trials, participants or independent replications. Confirmed totals are unrecorded and review of existing content remains incomplete.",
      "observed_result": "Tongue-only AHI P=.44 and ESS P=.62; 20 participants and completer analysis",
      "result_level": "Distinguish the original combined summary from individual bibliography. Retain Yoshioka eight-week no-intervention comparison, 20 participants, completer analysis and AHI/ESS P values. Poncin secondary ESS positivity or combined funding/device support is not copied into Yoshioka-specific results/support.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Existing stored review summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "The original PubMed URL and PMID 38529043, PMCID PMC10961225, DOI 10.2490/prm.20240010 and UMIN000041489 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 38529043, PMCID PMC10961225, DOI 10.2490/prm.20240010 and UMIN000041489 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "fulltext",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 38529043, PMCID PMC10961225, DOI 10.2490/prm.20240010 and UMIN000041489 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "registration",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 38529043, PMCID PMC10961225, DOI 10.2490/prm.20240010 and UMIN000041489 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        },
        {
          "material_type": "protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "The original PubMed URL and PMID 38529043, PMCID PMC10961225, DOI 10.2490/prm.20240010 and UMIN000041489 are preserved. Identifiers alone do not certify original-material acquisition, reading, prior plans or condition fulfillment; full-text/registration URLs are not newly inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/38529043/"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
      "section": "§8.1–8.2.3, Table 8.2.a",
      "official_principle": "Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M15",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15",
      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19",
      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    }
  ],
  "status_dictionary": {
    "Partly verified": "Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified",
    "Unverified": "Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety",
    "Review incomplete": "Awaiting user review",
    "Met": "Use only within the relevant condition's scope after user review; no automatic display in this preparation",
    "Not reported": "Distinguish only within materials actually read; do not turn unread external materials into unreported findings",
    "Inaccessible": "Not applied during this preparation because actual access was not tested",
    "Not applicable": "Use with a reason for non-applicability based on an explicit question boundary",
    "Conflicting data": "Judge after actual material comparison; review was not performed during this preparation",
    "Insufficient evidence for the conditions": "Do not use as a clinical grade encompassing currently unread materials"
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "Distinguish the R01 Guimarães multicomponent report from R02 Poncin/R03 Yoshioka tongue reports. The original parent tongue-evidence row combines two reports and is shared by two subclaim sheets. Historical checks of five RCTs and three current bibliographies are not the same count; unidentified reports and confirmed unique-trial, participant or independent-replication totals are not newly created. External details remain unread."
  },
  "history": [
    {
      "date": "2026-10-16",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "The public page and data were prepared from the existing 30 items. No new clinical search, verification-status change or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-16"
}