Efficacy of shankh blowing on moderate sleep apnoea: a randomised control trial

The aim was to determine the effect of shankh (conch shell) blowing on sleep-related outcomes in individuals with moderate obstructive sleep apnoea (OSA).

This was a prospective open-label randomised control trial with parallel groups including individuals with daytime sleepiness and recent moderate OSA diagnosis. Participants received either intervention of shankh blowing or a sham procedure (deep-breathing exercise) for 6 months. The primary outcome included daytime sleepiness (Epworth Sleepiness Scale; ESS) with two secondary outcomes of sleep quality (Pittsburgh Quality of Sleep Index; PSQI) and the apnoea-hypopnoea index (AHI). Linear mixed-effects models were used to assess outcomes.

Among 30 individuals with moderate OSA, 16 were randomised to the control group and 14 to the intervention group using unrestricted randomisation. Participants in the intervention group had a greater improvement in sleepiness with a 34% reduction in ESS score (change, -5.0 points, 95% CI -8.06- -1.93), and a significant change in the mean difference of the ESS score (-4.69 points, 95% CI -8.39- -1.007; p=0.0145) between groups at the end of the intervention. Sleep quality (PSQI score; change, -1.8 points, 95% CI -3.3- -0.26) and AHI (change, -4.4 events·h^-1, 95% CI -7.6- -1.2) were more reduced in the intervention group at 6 months, with a mean between-group difference of -3.1 points for PSQI score and -5.62 events·h^-1 for AHI.

The observed improvements in daytime sleepiness, sleep quality and AHI suggest that respiratory muscle training through shankh blowing may emerge as a novel therapeutic option for managing OSA symptoms in the future.