{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2992-s1",
  "verdict_number": "2992",
  "title": "Isolated tongue resistance training × AHI",
  "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 original report populations of 27 OSA patients in Poncin and 20 with mild-to-moderate sleep-disordered breathing in Yoshioka. Exact ages, diagnoses, baseline AHI/ESS, weight, exclusions, arm denominators and concurrent therapy are unverified. The 31-person multicomponent Guimarães trial is not copied as a tongue-only population, denominator or baseline.",
    "intervention": "Record isolated six-week tongue elevation and eight-week device-based tongue resistance within their original scopes. Retain differences in muscles, components, supervision, tools and adherence; multicomponent oropharyngeal exercise is separate background. Exact intensity, repetitions, device specifications and actual adherence are unverified; no new training methods are provided.",
    "dose": "Preserve original programs/durations only to identify studies. Exact tongue-only intensity, repetitions, actual exposure, resistance, instruction, missed sessions and discontinuation details are unverified. Total amounts, frequency and individual intensity are not newly converted; no training/treatment prescriptions are created.",
    "comparator": "Distinguish sham in Poncin from no intervention in Yoshioka. Actual sham movements, contact time, allocation awareness, measurement/analysis masking, concurrent standard therapy, medicines, weight and lifestyle-care differences are unverified. Different controls are not combined as the same comparison.",
    "endpoint": "The selected original claim is AHI improvement from isolated tongue resistance training, with subclaim grade D and note that primary AHI was null in two small trials. Distinguish Poncin null between-group primary AHI/positive secondary ESS from Yoshioka AHI P=.44/ESS P=.62. Exact tongue-only AHI values, units, measurement, models, effects, CIs and denominators are unverified. Multicomponent within-group values, tongue strength/endurance, sleepiness and app snoring are not transferred into selected AHI effects.",
    "duration": "Preserve original durations of six weeks in Poncin and eight weeks in Yoshioka. Exact assessment dates, actual exposure durations, discontinuation, later follow-up, long-term clinical outcomes and rare harms are unverified. Three months for the multicomponent program is not the duration for this tongue-only question; no standard-treatment replacement or method instructions are created.",
    "excluded_extensions": [
      "Copying or calculating within-exercise-group 22.4±4.8 to 13.7±8.5/h in the 31-person multicomponent trial as tongue-only baselines, comparative effects or CIs",
      "Converting Poncin secondary ESS, broad endurance wording, tongue strength, sleepiness or app snoring into primary AHI success",
      "Copying Yoshioka P=.44/P=.62, 20 participants or completer analysis into Poncin values, denominators or analyses",
      "Assigning one abrasion participant or device provision to a specific tongue trial without support, or using 27/20 participants as harm denominators",
      "Using historical five RCTs, reports, measures or two subclaim sheets as new unique-trial, participant or event totals, or independence certification",
      "Regrading original D/null results as zero effect, equivalence or null effects of every exercise, or filling subclaim scores with parent C46",
      "Creating new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, tongue/breathing training, standard-treatment replacement or procedure instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "What is the scope of the selected tongue-only question?",
      "needed": "Original Korean/English claim and boundaries from multicomponent/parent context",
      "role": "Required",
      "role_reason": "This condition connects Original Korean/English claim and boundaries from multicomponent/parent context with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Korean/English claim and boundaries from multicomponent/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: Detailed exposure and the effect of interest for the selected protocol are unverified. 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 selected original claim is 'AHI improvement from isolated tongue resistance training'. Distinguish multicomponent oropharyngeal AHI/symptoms and parent context covering multiple programs/endpoints; tongue-only AHI is recorded separately.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed exposure and the effect of interest for the selected protocol are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed exposure and the effect of interest for the selected protocol are unverified."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Are subclaim D and parent C46 distinguished?",
      "needed": "Original subclaim D/note and absent score/status",
      "role": "Required",
      "role_reason": "This condition connects Original subclaim D/note and absent score/status with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 subclaim D/note and absent score/status 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 fields are absent from the original. Parent values are not copied to fill them. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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 subclaim grade is D, with note that primary AHI was null in two small trials. Subclaim score/status are absent. Parent C46 is a historical verdict covering conflicting programs/endpoints, not a new subclaim score.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subclaim score/status fields are absent from the original. Parent values are not copied to fill them.",
      "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 fields are absent from the original. Parent values are not copied to fill them."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Are Poncin and Yoshioka populations the same?",
      "needed": "OSA, mild-to-moderate sleep-disordered breathing, eligibility and severity",
      "role": "Required",
      "role_reason": "This condition connects OSA, mild-to-moderate sleep-disordered breathing, eligibility and severity with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 OSA, mild-to-moderate sleep-disordered breathing, eligibility and severity 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 eligibility, diagnoses, baseline AHI, risks, ages and concurrent-treatment material are needed. 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": "Poncin bibliography concerns OSA patients; Yoshioka concerns mild-to-moderate sleep-disordered breathing. The parent has adult context. Exact ages, diagnoses, severity, baseline AHI, weight, exclusions and concurrent therapies for each tongue trial 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 eligibility, diagnoses, baseline AHI, risks, ages and concurrent-treatment material are needed.",
      "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 eligibility, diagnoses, baseline AHI, risks, ages and concurrent-treatment material are needed."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Are tongue elevation, device resistance and multicomponent exercise the same intervention?",
      "needed": "Muscles, components, supervision, tools and adherence",
      "role": "Required",
      "role_reason": "This condition connects Muscles, components, supervision, tools and adherence with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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: Protocol-specific intensity, repetitions, tools, supervision and actual adherence 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": "The original separates six-week sham-controlled tongue elevation, eight-week device-based tongue resistance with no-intervention control and three-month multicomponent oropharyngeal exercise. Retain the original boundary that muscles, components, supervision, tools and adherence define different interventions.",
      "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": "Protocol-specific intensity, repetitions, tools, supervision and actual adherence are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Protocol-specific intensity, repetitions, tools, supervision and actual adherence are unverified."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "What comparisons do sham and no intervention represent?",
      "needed": "Sham movements, contact, time, concurrent therapies and shared care",
      "role": "Required",
      "role_reason": "This condition connects Sham movements, contact, time, concurrent therapies and shared care with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Sham movements, contact, time, concurrent therapies and shared care 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: Sham components, no-intervention conditions, contact, concurrent therapy and equal-care material are needed. 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": "Distinguish tongue-only sham and no-intervention controls. Actual sham movements, contact time, concurrent standard therapy, medicines, other interventions and care-difference 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": "Sham components, no-intervention conditions, contact, concurrent therapy and equal-care material are needed.",
      "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": "Sham components, no-intervention conditions, contact, concurrent therapy and equal-care material are needed."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Which programs lasted six weeks, eight weeks and three months?",
      "needed": "Report-specific duration, assessment, exposure and later follow-up",
      "role": "Required",
      "role_reason": "This condition connects Report-specific duration, assessment, exposure and later follow-up with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 duration, assessment, exposure and later follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact assessment, actual exposure, discontinuation and later-follow-up material are needed. 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": "Preserve original correspondence between Poncin six weeks, Yoshioka eight weeks, Guimarães three months and their samples. Actual assessment dates, discontinuation, later follow-up and exact adherence durations 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": "Exact assessment, actual exposure, discontinuation and later-follow-up material are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact assessment, actual exposure, discontinuation and later-follow-up material are needed."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "How was tongue-only primary AHI measured and analyzed?",
      "needed": "AHI definition, units, measurement, original values, denominators and models",
      "role": "Required",
      "role_reason": "This condition connects AHI definition, units, measurement, original values, denominators and models with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 definition, units, measurement, original values, denominators and models 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 AHI definitions, measurement, original values, units, baselines, denominators and models are needed. 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 combined tongue summary describes primary AHI and null between-group results in two trials. Exact tongue-only AHI values, units, devices, scoring, baseline/change values, models and denominators 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 AHI definitions, measurement, original values, units, baselines, denominators and models are needed.",
      "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 AHI definitions, measurement, original values, units, baselines, denominators and models are needed."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "What was the original Poncin primary AHI result?",
      "needed": "Null comparative AHI, hierarchy, effects, CIs and denominators",
      "role": "Required",
      "role_reason": "This condition connects Null comparative AHI, hierarchy, effects, CIs and denominators with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Null comparative AHI, hierarchy, effects, CIs 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: Exact Poncin effects, P values, CIs, arm denominators and models are needed. Yoshioka values are not copied. 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 and its citation record null between-group primary AHI in Poncin. Exact Poncin arm AHI values, comparative estimates, P values, 95% CIs, denominators and models 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": "Exact Poncin effects, P values, CIs, arm denominators and models are needed. Yoshioka values are not copied.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact Poncin effects, P values, CIs, arm denominators and models are needed. Yoshioka values are not copied."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "Are secondary ESS and tongue endurance distinguished from AHI?",
      "needed": "Poncin ESS, broad endurance wording, hierarchy and attribution",
      "role": "Required",
      "role_reason": "This condition connects Poncin ESS, broad endurance wording, hierarchy and attribution with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Poncin ESS, broad endurance wording, hierarchy and attribution 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 ESS/endurance values, CIs, units, denominators and exact report attribution of endurance are needed. 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 citation records Poncin primary AHI null and secondary ESS positive. Broad parent wording states that positive ESS/tongue endurance were secondary to failed primary AHI. Exact values, report-specific endurance attribution and measurement 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": "Original ESS/endurance values, CIs, units, denominators and exact report attribution of endurance are needed.",
      "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 ESS/endurance values, CIs, units, denominators and exact report attribution of endurance are needed."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "What is the scope of Yoshioka AHI P=.44?",
      "needed": "Original null comparative AHI, P value, effects and denominators",
      "role": "Required",
      "role_reason": "This condition connects Original null comparative AHI, P value, effects and denominators with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 null comparative AHI, P value, effects 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: Yoshioka arm AHI original values, effects, CIs, denominators and models are needed. 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": "Preserve Yoshioka AHI P=.44 and null comparative wording in the original, combined summary and citation. Exact arm AHI values, effects, CIs, denominators and models 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": "Yoshioka arm AHI original values, effects, CIs, denominators and models are needed.",
      "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": "Yoshioka arm AHI original values, effects, CIs, denominators and models are needed."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "What separate result does ESS P=.62 represent?",
      "needed": "Yoshioka ESS, times, denominators and separation from AHI",
      "role": "Required",
      "role_reason": "This condition connects Yoshioka ESS, times, denominators and separation from AHI with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Yoshioka ESS, times, denominators and separation from AHI must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact ESS values, effects, CIs, denominators, plans and times are needed. 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": "The original and citation specify Yoshioka ESS P=.62. It differs from positive Poncin secondary ESS and is a separate endpoint from AHI. Original ESS values, effects, CIs, denominators, prior hierarchy and timing 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": "Exact ESS values, effects, CIs, denominators, plans and times are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact ESS values, effects, CIs, denominators, plans and times are needed."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Are within-group AHI values from the 31-person multicomponent trial the selected effect?",
      "needed": "Multicomponent exercise-group values and missing comparative estimates",
      "role": "Required",
      "role_reason": "This condition connects Multicomponent exercise-group values and missing comparative estimates with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 exercise-group values and missing comparative estimates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact multicomponent comparative change, CI, meaning of ±, arm denominators and models 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": "Distinguish Guimarães exercise-group AHI 22.4±4.8 to 13.7±8.5/h from unavailable exact between-group change and 95% CI. This is background from a 31-person three-month multicomponent program, not a direct tongue-only 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": "Exact multicomponent comparative change, CI, meaning of ±, arm denominators and models are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact multicomponent comparative change, CI, meaning of ±, arm denominators and models are unverified."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "How are multicomponent registered primary AHI and retrospective-registration wording retained?",
      "needed": "Guimarães NCT00660777, original hierarchy and registration timing",
      "role": "Required",
      "role_reason": "This condition connects Guimarães NCT00660777, original hierarchy and registration timing with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 NCT00660777, original hierarchy and registration timing 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 multicomponent registration content, dates, plans, changes and recruitment order are needed. 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 multicomponent evidence row records registered primary AHI; its citation contains NCT00660777 and historical retrospective-registration checking wording. Exact registration dates, recruitment order and original plans remain unread and do not replace tongue-only plans.",
      "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 multicomponent registration content, dates, plans, changes and recruitment order are needed.",
      "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 multicomponent registration content, dates, plans, changes and recruitment order are needed."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Do tongue strength/endurance, sleepiness and snoring answer AHI?",
      "needed": "Measure definitions, units, primary/secondary hierarchy and clinical links",
      "role": "Required",
      "role_reason": "This condition connects Measure definitions, units, primary/secondary hierarchy and clinical links with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Measure definitions, units, primary/secondary hierarchy and clinical links must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original values, measurement, hierarchy and AHI/clinical mediation links for each measure are needed. 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 does not convert tongue strength, sleepiness or snoring into AHI success. Broad secondary-positive wording is retained separately from AHI; direct mediation and clinical links 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": "Original values, measurement, hierarchy and AHI/clinical mediation links for each measure are needed.",
      "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 values, measurement, hierarchy and AHI/clinical mediation links for each measure are needed."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "What is the scope of app scores and snoring signals?",
      "needed": "Actual reports, measurement and direct AHI links",
      "role": "Required",
      "role_reason": "This condition connects Actual reports, measurement and direct AHI links with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Actual reports, measurement and direct AHI links must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: App/snoring original-report identity, measurement, values and direct AHI links are needed. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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 'reduced app snoring = reduced AHI' lacks direct evidence. Detailed bibliography/quantification for symptom signals in other snoring trials is unverified; hypothetical reports are not added.",
      "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": "App/snoring original-report identity, measurement, values and direct AHI links are needed.",
      "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": "App/snoring original-report identity, measurement, values and direct AHI links are needed."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "What are exact tongue-only effects, CIs and effects of interest?",
      "needed": "Comparative estimation, adjustment, CIs, models and clinical importance",
      "role": "Required",
      "role_reason": "This condition connects Comparative estimation, adjustment, CIs, models and clinical importance with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Comparative estimation, adjustment, CIs, models and clinical importance 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: Effects, CIs, effects of interest, adjustment, importance and equivalence plans are needed. 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": "Null comparative AHI wording for two tongue trials and Yoshioka P values are present, but exact effects of interest, adjustments, 95% CIs, minimal important differences and equivalence designs are unverified. Retain the original boundary that small null trials do not establish null effects for every exercise.",
      "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": "Effects, CIs, effects of interest, adjustment, importance and equivalence plans are needed.",
      "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": "Effects, CIs, effects of interest, adjustment, importance and equivalence plans are needed."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "What uncertainty remains with small samples of 27 and 20?",
      "needed": "Endpoint denominators, intervals, power and follow-up",
      "role": "Required",
      "role_reason": "This condition connects Endpoint denominators, intervals, power and follow-up with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 denominators, intervals, power and follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: AHI intervals, sample-size justification, power, importance and observation losses are needed. 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 parent identifies small studies and missing quantification as limitations. Original samples of 27 and 20 do not confirm precise null effects or universally rule out treatment effects; CIs and sample-size plans 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": "AHI intervals, sample-size justification, power, importance and observation losses are needed.",
      "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 intervals, sample-size justification, power, importance and observation losses are needed."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "What do 27 and 20 represent in each report?",
      "needed": "Original participants, arm allocation, completion and endpoint denominators",
      "role": "Required",
      "role_reason": "This condition connects Original participants, arm allocation, completion and endpoint denominators with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 participants, arm allocation, completion and endpoint 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: Arm allocation, completion, analysis, endpoint denominators and exclusions are needed. 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 records multicomponent 31, six-week 27 and eight-week 20 separately; the combined tongue row records 27 and 20. Arm allocation, completion, analysis and AHI/ESS/strength denominators in each tongue trial 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": "Arm allocation, completion, analysis, endpoint denominators and exclusions are needed.",
      "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, completion, analysis, endpoint denominators and exclusions are needed."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "How does Yoshioka completer analysis relate to missingness?",
      "needed": "Allocation, completion, discontinuation, exclusions and endpoint missingness",
      "role": "Required",
      "role_reason": "This condition connects Allocation, completion, discontinuation, exclusions and endpoint missingness with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Allocation, completion, discontinuation, exclusions and endpoint missingness must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Allocation, completion, arm losses, exclusions and measure-specific missingness/handling are needed. 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 Yoshioka citation marks 20 participants and completer analysis. Total allocation, arm completion/analysis, discontinuation, exclusions, AHI/ESS missing-data handling and Poncin flow 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": "Allocation, completion, arm losses, exclusions and measure-specific missingness/handling are needed.",
      "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": "Allocation, completion, arm losses, exclusions and measure-specific missingness/handling are needed."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "How much is known about random-sequence generation and concealment?",
      "needed": "Original randomized designs and actual generation, recruitment and allocation",
      "role": "Required",
      "role_reason": "This condition connects Original randomized designs and actual generation, recruitment and allocation with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 randomized designs and actual generation, recruitment and allocation 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 random-sequence generation, concealment, recruitment, allocation and baseline-risk procedures are needed. 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 combined tongue summary and bibliography of both tongue reports record randomized trials. Actual generation, concealment, recruitment order, arm allocation, baseline risks and implementation 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": "Actual random-sequence generation, concealment, recruitment, allocation and baseline-risk procedures are needed.",
      "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 random-sequence generation, concealment, recruitment, allocation and baseline-risk procedures are needed."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "What level of sham, participant and assessor masking is known?",
      "needed": "Contact, allocation awareness, measurement and analysis procedures",
      "role": "Required",
      "role_reason": "This condition connects Contact, allocation awareness, measurement and analysis procedures with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Contact, allocation awareness, measurement and analysis procedures 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: Masking, allocation awareness, sham content, contact, measurement and analysis procedures are needed. 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": "Distinguish Poncin sham from Yoshioka no intervention. Allocation awareness among participants, instructors, measurers and analysts, equal contact, sham movements, tools and measurement procedures 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": "Masking, allocation awareness, sham content, contact, measurement and analysis procedures are needed.",
      "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": "Masking, allocation awareness, sham content, contact, measurement and analysis procedures are needed."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are baseline AHI, severity, weight and analysis distinguished?",
      "needed": "Tongue-trial baselines, balance, covariates and adjustment",
      "role": "Required",
      "role_reason": "This condition connects Tongue-trial baselines, balance, covariates and adjustment with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Tongue-trial baselines, balance, covariates and adjustment must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Tongue-only baselines, covariates, balance, adjustment and models are needed. 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": "Exact tongue-only baseline AHI/ESS, severity, weight, arm balance and baseline handling/adjustment are unverified. Original within-group Guimarães 22.4 is not a tongue-only baseline.",
      "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": "Tongue-only baselines, covariates, balance, adjustment and models are needed.",
      "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": "Tongue-only baselines, covariates, balance, adjustment and models are needed."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "How were standard therapy, other care and training compared?",
      "needed": "Concurrent therapies, comparators, weight changes, treatment changes and analysis",
      "role": "Required",
      "role_reason": "This condition connects Concurrent therapies, comparators, weight changes, treatment changes and analysis with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Concurrent therapies, comparators, weight changes, treatment changes and analysis 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: Standard therapy, concurrent treatment, care, weight changes and analysis handling are needed. 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 summary records tongue-only/control programs, but details of concurrent standard therapy, other care, weight/treatment changes and model handling are unverified. Retain the original boundary that symptoms alone cannot determine 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": "Standard therapy, concurrent treatment, care, weight changes and analysis handling are needed.",
      "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": "Standard therapy, concurrent treatment, care, weight changes and analysis handling are needed."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "How are actual adherence, tools and intensity linked to results?",
      "needed": "Planned/actual exposure, resistance, supervision, discontinuation and analysis",
      "role": "Required",
      "role_reason": "This condition connects Planned/actual exposure, resistance, supervision, discontinuation and analysis with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Planned/actual exposure, resistance, supervision, discontinuation and analysis 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 intensity, frequency, adherence, supervision, discontinuation, exposure and analysis material are needed. 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 states that muscles, components, supervision, tools and adherence define different interventions. Actual resistance, frequency, instruction, missed sessions, discontinuation and exposure-specific effects in the tongue trials 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": "Actual intensity, frequency, adherence, supervision, discontinuation, exposure and analysis material are needed.",
      "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 intensity, frequency, adherence, supervision, discontinuation, exposure and analysis material are needed."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "What are allocation, completer and actual-use effects and missing-data handling?",
      "needed": "ITT/PP, adjustment, missingness, sensitivity and repeated measures",
      "role": "Required",
      "role_reason": "This condition connects ITT/PP, adjustment, missingness, sensitivity and repeated measures with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 ITT/PP, adjustment, missingness, sensitivity and repeated measures 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: ITT/PP, actual use, models, adjustment, missingness and sensitivity material are needed. 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": "Beyond original Yoshioka completer wording, ITT/PP, actual use, missingness, imputation, sensitivity, models and covariates in each tongue trial are unverified. Original comparative null wording is retained only within original-report scope.",
      "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": "ITT/PP, actual use, models, adjustment, missingness and sensitivity material are needed.",
      "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": "ITT/PP, actual use, models, adjustment, missingness and sensitivity material are needed."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "What do NCT/UMIN identifiers and the original primary hierarchy establish?",
      "needed": "Tongue-report registration, protocols, primary AHI and secondary outcomes",
      "role": "Required",
      "role_reason": "This condition connects Tongue-report registration, protocols, primary AHI and secondary outcomes with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Tongue-report registration, protocols, primary AHI and secondary 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: Registration content, dates, plans, hierarchy, analysis, recruitment order and change history are needed. 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": "Original tongue bibliography includes NCT03846349 and UMIN000041489; original evidence/citations record null primary AHI. Current registration content, dates, recruitment order, changes and analysis plans 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": "Registration content, dates, plans, hierarchy, analysis, recruitment order and change history are needed.",
      "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": "Registration content, dates, plans, hierarchy, analysis, recruitment order and change history are needed."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "How are tongue-only null results and multicomponent signals preserved together?",
      "needed": "Each comparator, duration, components, endpoints and quantification",
      "role": "Required",
      "role_reason": "This condition connects Each comparator, duration, components, endpoints and quantification with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Each comparator, duration, components, endpoints and quantification must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Direct comparisons under the same conditions, effects, CIs, independence and quantitative links 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": "The parent did not combine programs into blanket benefit or null conclusions. Retain separate scopes of multicomponent within-group signals, tongue-only primary null results and symptoms/strength/endurance; small null trials do not establish null effects for every possible exercise.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Direct comparisons under the same conditions, effects, CIs, independence and quantitative links 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": "Direct comparisons under the same conditions, effects, CIs, independence and quantitative links are unverified."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "How do two evidence groups, three bibliographies and historical five RCTs differ?",
      "needed": "Combined summaries, individual bibliography, historical study counts and cohorts",
      "role": "Required",
      "role_reason": "This condition connects Combined summaries, individual bibliography, historical study counts and cohorts with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 summaries, individual bibliography, historical study counts and cohorts 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: Related/additional reports, cohort overlap and unique-trial/participant totals 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": "The original contains two evidence rows and three citations. The parent decision historically describes five RCTs/registry cross-checking, but the full list and additional-report details are unverified. Link the combined tongue summary within each of two separate bibliographies; no hypothetical reports are added.",
      "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": "Related/additional reports, cohort overlap and unique-trial/participant totals 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": "Related/additional reports, cohort overlap and unique-trial/participant totals are unverified."
    },
    {
      "item_id": "N29",
      "question_type": "Evidence condition",
      "question": "Which trial and roles do public/university support and device provision concern?",
      "needed": "Report-specific support, COI, devices, design, analysis and independence",
      "role": "Required",
      "role_reason": "This condition connects Report-specific support, COI, devices, design, analysis and independence with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 support, COI, devices, design, analysis and independence 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: Individual attribution of support/device provision, COI, roles, research families and independence material are needed. 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 multicomponent row records limited funding verification; the combined tongue row records public/university support and device provision in one trial. Which trial received the device, and support, COI, design/analysis roles and independence 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": "Individual attribution of support/device provision, COI, roles, research families and independence material are needed.",
      "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": "Individual attribution of support/device provision, COI, roles, research families and independence material are needed."
    },
    {
      "item_id": "N30",
      "question_type": "Evidence condition",
      "question": "Do the studies answer post-training AHI and clinical outcomes?",
      "needed": "Later follow-up, other conditions, subgroups and treatment changes",
      "role": "Required",
      "role_reason": "This condition connects Later follow-up, other conditions, subgroups and treatment changes with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Later follow-up, other conditions, subgroups and treatment changes 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: Later follow-up, clinical outcomes, other conditions, subgroups and treatment-change material are needed. 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": "There is assessment context for six/eight-week tongue programs, but post-training AHI, clinical events, other durations/intensities/subgroups and standard-treatment-replacement material are unverified. Retain the original boundary that symptoms alone cannot determine severity or 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": "Later follow-up, clinical outcomes, other conditions, subgroups and treatment-change material are needed.",
      "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": "Later follow-up, clinical outcomes, other conditions, subgroups and treatment-change material are needed."
    },
    {
      "item_id": "N31",
      "question_type": "Evidence condition",
      "question": "What material was actually read here?",
      "needed": "Complete stored summary/bibliography versus external originals",
      "role": "Required",
      "role_reason": "This condition connects Complete stored summary/bibliography versus external originals with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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/bibliography 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: External originals remain unread. Access failure or inaccessibility was not established either. 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 stored parent 2992 summary and original bibliography were used and originals preserved. The three reports were read as summaries; external abstracts, full texts, registration, plans and support material remain unread without access attempts. The 24 material slots comprise three stored summaries and 21 unread/needed external-material slots.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "External originals remain unread. Access failure or inaccessibility was not established either.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "External originals remain unread. Access failure or inaccessibility was not established either."
    },
    {
      "item_id": "N32",
      "question_type": "Evidence condition",
      "question": "Are historical cross-checking and current review distinguished?",
      "needed": "Original date, empty corrections/deliberation and historical decision",
      "role": "Required",
      "role_reason": "This condition connects Original date, empty corrections/deliberation and historical decision with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 historical decision 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: Current content-review and new clinical-verification dates are unrecorded; review of existing content remains incomplete. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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. Historical checking of five RCTs, registration and primary outcomes is a parent history record, not completed current review.",
      "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": "Current content-review and new clinical-verification dates are unrecorded; 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": "Current content-review and new clinical-verification dates are unrecorded; review of existing content remains incomplete."
    },
    {
      "item_id": "N33",
      "question_type": "Evidence condition",
      "question": "Are original Korean/English tongue-only, multicomponent, primary and symptom boundaries retained?",
      "needed": "Original subclaim/note, parent Korean/English and safety",
      "role": "Required",
      "role_reason": "This condition connects Original subclaim/note, parent Korean/English and safety with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 subclaim/note, parent Korean/English and safety 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 translation/correction comparisons between external papers and original Korean/English remain unverified. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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 English subclaim is 'AHI improvement from isolated tongue resistance training', with note that primary AHI was null in two small trials. Parent English also distinguishes multicomponent/tongue-only and primary outcomes/symptoms/strength. No detailed external comparison was performed.",
      "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 translation/correction comparisons between external papers and original Korean/English remain unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed translation/correction comparisons between external papers and original Korean/English remain unverified."
    },
    {
      "item_id": "N34",
      "question_type": "Evidence condition",
      "question": "How are parent axes and failed primary/positive secondary outcomes retained?",
      "needed": "Parent axes, original flags and absent subclaim axes",
      "role": "Required",
      "role_reason": "This condition connects Parent axes, original flags and absent subclaim axes with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 axes, original flags and absent subclaim 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: Selected-subclaim score, status and axes are absent; details of each original endpoint plan are unverified. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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 axes are B/S/R0/I1/EX/B2/CX; the primary-failed-secondary-positive flag is true. Coprimary split, large hard-endpoint RCT and no-human-study flags are false. Derived grade is C; override is an empty string. Subclaim score, status and axes are absent from the original.",
      "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": "Selected-subclaim score, status and axes are absent; details of each original endpoint plan 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": "Selected-subclaim score, status and axes are absent; details of each original endpoint plan are unverified."
    },
    {
      "item_id": "N35",
      "question_type": "Evidence condition",
      "question": "Which trial does the one mucosal-abrasion participant belong to?",
      "needed": "Event attribution, definition, collection, adjudication and denominator",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Event attribution, definition, collection, adjudication and denominator with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Event attribution, definition, collection, adjudication and denominator 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: Trial attribution, definitions, collection, adjudication, exposure and observation denominators for the abrasion are needed. 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 safety wording records one exercise-arm participant in a tongue-training trial temporarily stopping because of an oral mucosal abrasion, then resuming. Exact trial attribution, definition, collection, adjudication and denominators are unverified in the current summary.",
      "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": "Trial attribution, definitions, collection, adjudication, exposure and observation denominators for the abrasion are needed.",
      "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": "Trial attribution, definitions, collection, adjudication, exposure and observation denominators for the abrasion are needed."
    },
    {
      "item_id": "N36",
      "question_type": "Evidence condition",
      "question": "What are abrasion onset, stopping/resumption and follow-up times?",
      "needed": "Actual exposure, onset, recovery, stopping, recurrence and follow-up",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Actual exposure, onset, recovery, stopping, recurrence and follow-up with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Actual exposure, onset, recovery, stopping, recurrence and follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Event, recovery, discontinuation duration, recurrence and later-follow-up times are needed. 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 records resumption after temporary discontinuation. Exposure, onset, recovery, discontinuation duration, recurrence, later harm follow-up and exact trial attribution 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": "Event, recovery, discontinuation duration, recurrence and later-follow-up times are needed.",
      "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": "Event, recovery, discontinuation duration, recurrence and later-follow-up times are needed."
    },
    {
      "item_id": "N37",
      "question_type": "Evidence condition",
      "question": "Were harms collected equally in sham/no-intervention groups?",
      "needed": "Arm collection, observation, control events and denominators",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Arm collection, observation, control events and denominators with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Arm collection, observation, control events 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: Equal harm collection/observation, control events, denominators and comparative material are needed. 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": "Tongue-only sham/no-intervention comparisons exist, but equal harm collection, observation periods, control event counts/denominators, comparative risks and attribution of the one participant 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": "Equal harm collection/observation, control events, denominators and comparative material are needed.",
      "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": "Equal harm collection/observation, control events, denominators and comparative material are needed."
    },
    {
      "item_id": "N38",
      "question_type": "Evidence condition",
      "question": "Are exposure/observation denominators and abrasion frequency known?",
      "needed": "Exact trial/arm, actual exposure, follow-up, harms and discontinuation",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Exact trial/arm, actual exposure, follow-up, harms and discontinuation with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Exact trial/arm, actual exposure, follow-up, harms and discontinuation 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: Harm attribution, exposure, follow-up, arm denominators and total harm counts are needed. No new frequencies or risks are calculated. 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 describes one abrasion participant, but exposure/observation denominators, arm/trial attribution, total harms and missingness are unverified. Original samples of 27 and 20 are not that harm denominator.",
      "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": "Harm attribution, exposure, follow-up, arm denominators and total harm counts are needed. No new frequencies or risks are calculated.",
      "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": "Harm attribution, exposure, follow-up, arm denominators and total harm counts are needed. No new frequencies or risks are calculated."
    },
    {
      "item_id": "N39",
      "question_type": "Evidence condition",
      "question": "Are tools, training, baseline conditions and event causes distinguished?",
      "needed": "Tools, actual exposure, baseline oral conditions/disease, concurrent care and cause",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Tools, actual exposure, baseline oral conditions/disease, concurrent care and cause with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Tools, actual exposure, baseline oral conditions/disease, concurrent care and cause 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: Tools, exposure, baseline conditions, event attribution, timing and causal assessment are needed. 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": "Original mucosal-abrasion/temporary-stopping wording exists, but tool/program attribution, actual exposure, baseline conditions, concurrent care, timing and causal-adjudication 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": "Tools, exposure, baseline conditions, event attribution, timing and causal assessment are needed.",
      "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": "Tools, exposure, baseline conditions, event attribution, timing and causal assessment are needed."
    },
    {
      "item_id": "N40",
      "question_type": "Evidence condition",
      "question": "What are stopping, completer analysis and losses to harm follow-up?",
      "needed": "Event stopping/resumption, losses, harm missingness and selective reporting",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Event stopping/resumption, losses, harm missingness and selective reporting with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Event stopping/resumption, losses, harm missingness and selective reporting 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: Harm-related stopping, losses, missingness, selective reporting and follow-up losses are needed. 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": "Temporary stopping/resumption and Yoshioka completer analysis are separate original records. Arm-specific stopping/losses, missing or selected harm reporting and later follow-up in each report are unverified. The two statements are not linked as the same trial/participant.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Harm-related stopping, losses, missingness, selective reporting and follow-up losses are needed.",
      "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": "Harm-related stopping, losses, missingness, selective reporting and follow-up losses are needed."
    },
    {
      "item_id": "N41",
      "question_type": "Evidence condition",
      "question": "What is known about other populations, independent reports and later harms?",
      "needed": "Same protocol, vulnerable populations, severity and long-term follow-up",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Same protocol, vulnerable populations, severity and long-term follow-up with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Same protocol, vulnerable populations, severity and long-term follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Independent harm material, vulnerable/severe populations and post-training follow-up are needed. 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": "Stored scope covers program-specific AHI/symptoms and one abrasion participant with unverified attribution. Independent harm reports under the same protocol, other severities/disease populations and post-training observation 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": "Independent harm material, vulnerable/severe populations and post-training follow-up are needed.",
      "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": "Independent harm material, vulnerable/severe populations and post-training follow-up are needed."
    },
    {
      "item_id": "N42",
      "question_type": "Evidence condition",
      "question": "Are criteria/original preservation distinguished from content review?",
      "needed": "Preserved methodology, condition versions, separate application and actual review scope",
      "role": "Required",
      "role_reason": "This condition connects Preserved methodology, condition versions, separate application and actual review scope with tongue-only AHI, original grade D, report-specific populations, sham/no-intervention controls, six/eight weeks, primary versus secondary outcomes, denominators and harm attribution.",
      "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 Preserved methodology, condition versions, separate application and actual review 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: Update with records of original material, condition versions, separate application, change history and actual review scope. This records needed materials; no new research was executed.",
      "current_reports": [],
      "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": "Preserved methodology, claim-type conditions and review-scope material were referenced. Condition freezing and separate observation application are distinguished from actual original-material reading/content review. Existing content review remains incomplete; this does not establish official-method certification or new clinical verification.",
      "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": "Update with records of original material, condition versions, separate application, change history and actual review scope.",
      "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": "Update with records of original material, condition versions, separate application, change history and actual review scope."
    }
  ],
  "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": "Original multicomponent background report",
      "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": "Background within-exercise-group AHI from the 31-person three-month multicomponent trial. Retain original registered primary AHI, AHI/ESS signals and retrospective-registration wording; exact comparative effects, 95% CI, the meaning of ±, denominators and plans are unverified. They are not transferred into tongue-only baselines, comparative effects, intervals or duration.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "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": "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": "Full text",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "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": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Analysis plan and original tables",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Intervention and harms",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Support and interests",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Actual bibliography linked separately from the combined tongue summary; no certification of unique counts or independence",
      "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": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "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": "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": "Full text",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "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": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Analysis plan and original tables",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Intervention and harms",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Support and interests",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Actual bibliography linked separately from the combined tongue summary; no certification of unique counts or independence",
      "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": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "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": "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": "Full text",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "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": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Analysis plan and original tables",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Intervention and harms",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Support and interests",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "The original 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": "Methodological principles stated in existing pilot materials and condition templates were referenced. The methodological text was not reviewed again in this work."
    },
    {
      "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": "Methodological principles stated in existing pilot materials and condition templates were referenced. The methodological text was not reviewed again in this work."
    },
    {
      "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": "Methodological principles stated in existing pilot materials and condition templates were referenced. The methodological text was not reviewed again in this work."
    },
    {
      "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": "Methodological principles stated in existing pilot materials and condition templates were referenced. The methodological text was not reviewed again in this work."
    },
    {
      "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": "Methodological principles stated in existing pilot materials and condition templates were referenced. The methodological text was not reviewed again in this work."
    }
  ],
  "status_dictionary": {
    "Met": "The original content has been reviewed as meeting the conditions. This status is not used in this preparation.",
    "Partly verified": "Some information in the stored summary was linked during preparation; clinical verification or review is not complete.",
    "Unverified": "Required direct values, definitions or materials have not been established within the current storage and reading scope. This does not mean zero effect, no papers or failed access.",
    "Review incomplete": "Awaiting user review, or actual review remains incomplete.",
    "Not reported": "Used only when original materials were actually read and the outcome was judged unreported. Not used for external materials unread in this work.",
    "Inaccessible": "Used only when an actual access attempt has a recorded failure. Not used for access that was not attempted in this work.",
    "Insufficient evidence for the conditions": "Indicates insufficient direct materials for the relevant scope or conditions; it is not a new grade.",
    "Not applicable": "Used when the reason it does not apply to the original question is stated.",
    "Conflicting data": "Retains the scope of conflicting statements in original materials; it is not an arbitrary reassessment."
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "The original parent and two subclaim sheets share the same report context. R01 Guimarães is multicomponent background; distinguish the original combined tongue summary into R02 Poncin six weeks/27 participants/sham and R03 Yoshioka eight weeks/20 participants/no intervention. Three current bibliographies, historical checks of five RCTs, repeated measures and material slots are not counted as new unique trials, participants, events or independent replications. Confirmed totals and external details are unverified."
  },
  "history": [
    {
      "date": "2026-10-16",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "Public pages and materials were created from the existing 42 items. No new clinical search, verification-status change, or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-16"
}