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

Objectives To determine the effect of blowing shankh (conch shell) on sleep related outcomes in individuals with moderate obstructive sleep apnea (OSA). Methods 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. Primary outcome included Daytime sleepiness (Epworth Sleepiness scale, ESS) with two secondary outcomes: sleep quality (Pittsburgh quality of sleep index, PSQI) and apnea-hypopnea index (AHI). Linear mixed effects models were used to assess outcomes. Results Among 30 individuals with moderate OSA, 16 were randomised to the control group and 14 to the intervention group using unrestricted randomisation. Participants in intervention group observed greater improvement in sleepiness with 34% reduction in ESS (change, −5.0 points; 95% CI, (−8.06 to −1.93), and there is significant change in mean difference of ESS score (−4.69 points [95% CI, −8.39 to −1.007; p=0.0145]) between the groups at end of intervention. Sleep quality (PSQI score; change, −1.8 points [95% CI, −3.3 to −0.26]) and AHI (change, −4.4 events·h −1 [95% CI, −7.6 to −1.2]) were more reduced in intervention group at 6 months with mean between-group difference of −3.1 points for PSQI score and −5.62 events·h −1 for AHI respectively. Conclusions 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.