{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:03:27Z","timestamp":1787065407094,"version":"build-2736575974"},"reference-count":40,"publisher":"European Respiratory Society (ERS)","issue":"6","license":[{"start":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T00:00:00Z","timestamp":1754784000000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2025,5,29]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim was to determine the effect of shankh (conch shell) blowing on sleep-related outcomes in individuals with moderate obstructive sleep apnoea (OSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"method\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2005months. 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\u2013hypopnoea index (AHI). Linear mixed-effects models were used to assess outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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, \u22125.0 points, 95% CI \u22128.06\u2013\u2009\u22121.93), and a significant change in the mean difference of the ESS score (\u22124.69 points, 95% CI \u22128.39\u2013\u2009\u22121.007; p=0.0145) between groups at the end of the intervention. Sleep quality (PSQI score; change, \u22121.8 points, 95% CI \u22123.3\u2013\u2009\u22120.26) and AHI (change, \u22124.4\u2005events\u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      , 95% CI \u22127.6\u2013\u2009\u22121.2) were more reduced in the intervention group at 6\u2005months, with a mean between-group difference of \u22123.1 points for PSQI score and \u22125.62\u2005events\u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      for AHI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  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