A randomized controlled trial investigating the effect of thermal steam spray on nasal condition, neurological function, and sleep quality in young adults with nasal congestion and irregular sleep patterns

A randomized controlled trial investigating the effect of thermal steam spray on nasal condition, neurological function, and sleep quality in young adults with nasal congestion and irregular sleep patterns | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A randomized controlled trial investigating the effect of thermal steam spray on nasal condition, neurological function, and sleep quality in young adults with nasal congestion and irregular sleep patterns Jaehoon Kim, Jaehoon Hwang, Kyungryul Chung, Youngsoo Jin, Yong-Seok Jee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7253632/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Intranasal thermal steam spray (ITSS) has been suggested to relieve nasal stuffiness and improve sleep-related symptoms. However, its effects on respiratory capacity, neurological functions, including autonomic nervous system (ANS) and brain activities, remain underexplored. Therefore, this study aimed to investigate the effects of an ITSS intervention on nasal condition, respiratory and neurological functions, and sleep quality in young adults with nasal congestion and irregular sleep patterns. Methods Sixty university students (aged 20–26 years) with an average duration of nasal congestion and sleep irregularity of over three years participated. Two dormitories were randomly assigned to either a control group (CON; n = 30) or an intervention group (ITSS; n = 30). The ITSS device, delivering 43°C thermal wet steam using jet stream technology, was administered for 15 min, 3 times per week, 30 min before bedtime for 8 weeks. Results After the intervention, subjective nasal congestion and sleep conditions deteriorated in the CON but improved in the ITSS ( p < 0.001). Pulmonary outcomes, including reduced respiratory rate ( p < 0.001) and increased FEV₁ ( p < 0.001) and PEF ( p < 0.001), improved only in the ITSS. Heart rate variability and blood pressure indices also showed favourable changes. EEG analysis revealed increased wide band, alpha, and gamma powers in the ITSS, contrasting with declines in the CON ( p < 0.05). In the ITSS group, PSQI-K components improved, with daytime dysfunction reduced by 32.78 ± 41.40% ( p < 0.001). Total PSQI-K scores rose in the CON group (+14.64 ± 22.44%) but declined in the ITSS group (−38.90 ± 21.99%), showing a significant difference ( p < 0.0001). Conclusions These findings suggest that ITSS enhances airflow by humidifying the nasal environment, thereby facilitating respiratory function and stabilizing ANS activity and brain function. This process ultimately contributes to improved overall sleep quality in young adults experiencing nasal congestion and irregular sleep patterns. Trial registration The study was retrospectively registered on April 3, 2025, in the Clinical Research Information Service (https://cris.nih.go.kr/cris/search/listDetail.do/) under registration number KCT0010381. Intranasal steam Nasal congestion Sleep quality Autonomic nervous system EEG Heart rate variability PSQI Respiratory function Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Respiration is an essential life-sustaining activity that delivers oxygen to all cells of the human body, enabling normal physiological functions. While breathing can occur through both the nasal and oral cavities, the nose is the primary organ responsible for respiratory capacity [ 1 ]. The respiratory system comprises from nasal cavity to lungs, facilitating oxygen intake through the nasal passages and its circulation throughout the body via alveoli in the lungs [ 2 ]. For efficient respiration, the intranasal airway must remain unobstructed [ 3 ]. However, various conditions such as nasal septal deviation, colds, sinusitis, and allergic rhinitis can lead to nasal congestion or obstruction [ 4 ]. Nasal congestion including abnormal rhinitis or can compromise nasal respiratory function, thereby disrupting the sleep–wake cycle [ 5 ]. Such impairment has been associated with various sleep disorders, including insomnia, hypersomnia, and so on [ 6 ]. Irregular sleep patterns—especially those linked to nasal dysfunction—have been shown to impair respiratory function and are further associated with elevated stress levels, increased fatigue, and declines even in cognitive performance and concentration [ 7 ] Ultimately, maintaining an optimal intranasal airway is a crucial factor in ensuring a high quality of life and overall health [ 8 ]. Previous studies addressing the management of intranasal conditions have proposed a range of interventions, including pharmacological therapies (e.g., antihistamines, intranasal corticosteroids), surgical procedures (e.g., septoplasty, turbinate reduction), and conservative treatment approaches (e.g., nasal irrigation, steam inhalation) [ 9 – 11 ]. However, although various therapeutic strategies exist to improve the intranasal environment, surgical interventions often entail significant economic burden, while pharmacological treatments may lead to adverse side effects [ 12 ]. Additionally, conservative approaches frequently require complex preparation, contributing to practical inconvenience, further highlighting the need for more effective and safer solutions aimed at relieving intranasal congestion to improve sleep quality [ 13 ]. Recently, an intranasal thermal steam spray (ITSS) device has been developed and is gaining attention for its effectiveness in alleviating intranasal congestion while ensuring biocompatibility. This home healthcare device operates by delivering 43°C moisture steam into the intranasal cavity, providing a safe and efficient solution for nasal congestion or obstruction [ 14 ]. However, despite its demonstrated effectiveness in alleviating intranasal congestion, no studies to date have explored its potential impact on respiratory capacity and sleep quality. In particular, there is a significant lack of research investigating whether the flow of air circulating through an optimal respiratory pathway influences the autonomic nervous system (ANS) regulation and, in turn, affects stable brain activity. Therefore, the present study aimed to investigate the potential benefits of ITSS in improving the intranasal wet environment and its consequent effects on respiratory capacity, ANS function and brain activity. Furthermore, this study sought to determine whether these effects translate into measurable improvements in sleep quality. Materials and methods Study design This study was designed as a randomized, double-blinded, sham-controlled trial. Following approval by the Hanseo University Institutional Review Board (HS24-12-18), the study investigated the efficacy of ITSS through an interventional approach. Participants underwent an eight-week ITSS intervention (April 7, 2025 to June 2, 2025), followed by assessments and analyses of its impact on subjective nasal congestion, perceived sleep condition, respiratory performance, neurological function including ANS and brain activities, and overall sleep quality. This study obtained written informed consent in accordance with the Declaration of Helsinki [ 15 ] and was retrospectively registered on ClinicalTrials.gov under the identifier KCT0010381 on April 3, 2025. This study adhered to the CONSORT guidelines published in 2025 [ 16 ], and the completed checklist is provided in the supplementary materials (Supplementary Table 1). Participants The participants were male and female university students aged between 20 and 26 years, residing in two dormitories on the same university campus. They expressed interest in the study after viewing a social media advertisement related to the research, reporting symptoms of nasal congestion and sleep disturbances. Participants were instructed to carry out their daily activities and meals within their assigned dormitories and were asked not to disclose their involvement in the study to others. The inclusion criteria for this study required participants to exhibit symptoms such as clear nasal discharge, sneezing, nasal congestion, and nasal itching, along with irregular sleep patterns. Participants were assessed to determine whether their symptoms were occasional or persistent and to identify periods of symptom exacerbation. Subsequently, an otolaryngologist conducted a diagnostic evaluation for rhinitis, including nasal examination and nasal secretion analysis. Meanwhile, individuals diagnosed with congenital nasal obstruction, such as congenital pyriform aperture stenosis, or those with chronic diseases affecting the heart, lungs, or other major organs were excluded from this study. Additionally, individuals who had been regularly participating in an exercise program for more than six months, were heavy smokers, engaged in high-risk alcohol consumption as defined by the WHO, or had metabolic syndrome were also excluded [ 17 ]. Individuals with a prior diagnosis of cardiovascular or cerebrovascular disease, cancer, or psychiatric conditions were likewise excluded from the study. The sample size was determined via G*Power (ver.3.1.9.7; Heinrich-Heine-Universität, Düsseldorf, Germany), with assumptions including an effect size of f²( V ) = 0.25, an α error probability of 0.05, a power of 0.95, two groups, and two measurements [ 18 ]. The minimum required sample size was 54 participants. As shown in Fig. 1 , a total of 68 participants were recruited; however, 4 were excluded because they failed to meet the inclusion criteria or for personal reasons. Among the remaining 64 participants who completed the demographic survey and baseline assessment, random tags were used to assign one facility to the control group (CON) and another facility to the ITSS group. The principal investigator carried out all these procedures. A total of 32 participants were assigned to the CON at one facility, while another 32 participants were allocated to the ITSS group at a separate facility. During the eight-week program, two participants from the CON and two participants from the ITSS group dropped out during the follow-up stage. No participants from either group were excluded during the analysis, resulting in a final sample of 30 participants in each group: the CON and the ITSS group. Standardized guidelines were implemented for pre- and post-assessments to ensure strict blinding throughout the study. ITSS intervension program An intranasal vapor spray device (RhinoCare Korea Inc., Gumi, Korea) is a medical device certified by the Ministry of Food and Drug Safety for the treatment of nasal congestion caused by rhinitis, sinusitis, colds, and flu. This device facilitates breathing by utilizing Jet Stream technology (80 mmH₂O), which delivers 43°C vapor heat to the intranasal cavity through an internal heating mechanism, and its effectiveness has been recognized. Additionally, it has met safety standards for medical devices, including the residual wave test, as verified by an authorized testing agency [ 14 ]. Participants in the ITSS group were instructed to use the device for 15 min, three times per week, for eight weeks, activating it 30 min before bedtime. Meanwhile, participants in the CON were provided with the device without vapor heat emission and were instructed to use it under the same conditions as the ITSS group. Outcome measures Anthropometric data Anthropometric measurements were conducted on the first and final days of the intervention between 7:00 a.m. and 8:00 a.m., prior to breakfast. To ensure measurement accuracy, assessments were primarily performed on participants who had refrained from fluid intake and had completed both urination and defecation beforehand. Height was measured using an automated stadiometer while participants wore lightweight gowns. Body weight, fat mass, and muscle mass were assessed using the InBody 720 device (BioSpace, Seoul, Korea) with participants standing after a 10-hour fasting period. Body mass index (BMI) was also calculated based on the weight-to-height ratio. Clinical data To monitor external variables, participants were asked to complete a questionnaire between 9:00 p.m. and 10:00 p.m. each night prior to sleep, recording dietary intake and daily activities. In addition, between 7:00 a.m. and 8:00 a.m. each morning, the degree of subjective nasal openness and perceived post-sleep condition were assessed using a visual analogue scale (VAS). First, all participants in both groups consumed three meals per day, prepared under the supervision of a certified nutritionist. The daily caloric intake was set at 2,400–2,700 kcal, with a predominantly plant-based dietary regimen. To ensure accuracy and adherence, a researcher recorded participants’ daily dietary intake using CAN-Pro 5.0 ( http://canpro5.kns.or.kr ; Korean Nutrition Society). Second, physical activity (PA) levels were assessed using the International PA Questionnaire-Short Form [ 19 ]. Third, all participants were instructed to evaluate the subjectively felt degree of nasal congestion and their post-sleep condition each morning upon waking, using a VAS-based recording sheet delivered via direct message. The perceived degree of nasal dilatation was determined using a VAS [ 20 ]. The left end of a 10 cm long line was placed as ‘open nasal cavity (0)’ and the right end was placed as ‘blocked nasal cavity (10)’, and they were asked to mark the degree of nasal congestion they felt. A quantitative test of post-sleep condition was also conducted using the VAS. The left end of a 10 cm long line was placed as ‘no discomfort with sleep (0)’ and ‘severe discomfort with sleep (10)’, and they were asked to mark the sleep problems he or she felt. These clinical data were continuously monitored throughout the entire duration of the intervention period. The collected data were analysed on a weekly and monthly basis. Respiratory capacity, blood pressure and heart rate variability Respiratory capacity, blood pressure (BP), and heart rate variability (HRV) used to assess ANS function was measured between 7:00 a.m. and 8:00 a.m. on the first and final days of the intervention. First, resting respiratory rate was assessed by observing chest movement while participants lay in a supine position on a bed for 60 sec. Subsequently, pulmonary function was evaluated using a Spirovit SP-1 spirometer (SCHILLER AG, Switzerland). Key respiratory variables measured included forced expiratory volume in one second (FEV₁) and peak expiratory flow (PEF). For testing, participants wore a nasal clip to prevent air leakage and inserted a disposable mouthpiece into their mouths. They were instructed to exhale forcefully through the mouth following a maximal inhalation to measure the targeted respiratory parameters. Prior to the actual data collection, participants underwent practice sessions to familiarize themselves with the spirometry technique. Each participant performed the test three times, and the highest value recorded among the trials was used for statistical analysis [ 21 ]. Second, resting BP was measured using an automated sphygmomanometer. For the assessment, an appropriately sized cuff was placed on the brachial artery of the right arm. Third, to assess ANS activity, HRV was measured using the uBiomacpa device (Biosensecreative Co. Ltd. Seoul, Korea). Participants were instructed to refrain from exercise and alcohol consumption the day before the assessment, and to avoid food or caffeine intake for at least three hours prior to testing. HRV measurements were taken twice on the day of the experiment, and the average values were used for analysis [ 22 – 25 ]. During the measurement, participants sat comfortably for 2–3 min while pulse waves were non-invasively recorded via a sensor attached to the index finger. To ensure data reliability, participants were advised to remain still and avoid talking, coughing, or deep breathing during the procedure. The analysis included both time-domain measures and frequency-domain parameters derived from power spectral density estimates using autoregressive modeling [ 26 ]. In time-domain analysis, HRV is assessed by measuring the intervals between successive normal QRS complexes, referred to as normal-to-normal (NN) intervals. Two key time-domain metrics are used: the standard deviation of NN intervals (SDNN), which reflects overall HRV by capturing all cyclic components, and the root mean square of successive differences between NN intervals (RMSSD), which primarily reflects parasympathetic activity. In contrast, frequency-domain analysis examines the spectral components of HRV. This includes low-frequency (LF) and high-frequency (HF) bands, which are associated with sympathetic and parasympathetic nervous system activity, respectively. The LF/HF ratio, calculated from normalized LF and HF values, served as an index of sympathetic modulation [ 27 ]. To enhance data accuracy, the first hour of recording was excluded from analysis [ 22 ], and any transient noise or movement artifacts were manually removed. Electroencephalogram data measures Electroencephalography (EEG) recordings were conducted between 7:00 a.m. and 8:00 a.m. on both the first and final days of the intervention period. Prior to EEG acquisition, participants underwent a 10-min resting period in a quiet and thermally controlled indoor environment to ensure physiological stabilization. Subsequently, resting EEG was recorded for 5 min while participants remained seated in a relaxed posture with their eyes gently closed [ 28 , 29 ]. EEG data were acquired using a 10-channel wired EEG system (Neurofeedback Intermediate System, Montreal, Quebec, Canada). Scalp electrodes were affixed according to the international 10–20 system, targeting the frontal (F3, F4, Fz), temporal (T3, T4), parietal (P3, P4), and central regions. Reference electrodes were attached via ear clips on both earlobes. The sampling rate was configured at 500 Hz. Signal preprocessing included the application of a 60 Hz notch filter to remove power line interference and a bandpass filter to attenuate low- and high-frequency noise. Ocular artifacts, such as eye blinks, were eliminated using Independent Component Analysis. Power spectral analysis was subsequently performed using Fast Fourier Transform, yielding absolute and relative power values across predefined frequency bands. To investigate the potential effects of nasal congestion on alterations in sleep-related EEG patterns, spectral power was examined across the entire brain in the wide band range and within specific frequency domains: delta (0.5–4 Hz; relative power: 0–20%), theta (4–8 Hz; 5–20%), alpha (8–12 Hz; 20–40%), beta (13–30 Hz; 10–30%), and gamma (> 30 Hz; 3–10%) [ 30 ]. Furthermore, to enable a more refined assessment of neural activity, the alpha / beta ratio (ABR) and theta / beta ratio (TBR) were computed and analyzed. Sleep quality measures The Pittsburgh Sleep Quality Index (PSQI) is a standardized self-report questionnaire designed to assess sleep quality and patterns over the past month. It is widely utilized in clinical and research settings to evaluate sleep disturbances and insomnia. Originally developed by Buysse et al. [ 31 ], the PSQI has been adapted into various languages, including Korean. This study employed the Korean version of the PSQI (PSQI-K), which comprises 18 items across seven domains: subjective sleep quality (1 item), sleep latency (2 items), sleep duration (1 item), sleep efficiency (2 items), sleep disturbances (9 items), use of sleep medication (1 item), and daytime dysfunction (2 items). The PSQI-K has demonstrated high reliability, with a Cronbach’s α of 0.779. Each domain is scored on a scale of 0 to 3, yielding a total score ranging from 0 to 21, where higher scores indicate poorer sleep quality. In this study, sleep quality was classified based on the criteria established by Shon et al. [ 32 ]. A PSQI-K total score of 8.5 points or lower was categorized as "good sleep quality," while a score exceeding 8.5 points was classified as "poor sleep quality." Statistical analysis Statistical analyses were performed using GraphPad Prism 10.4.1 software (GraphPad Software, Boston, MA, USA). Descriptive statistics, including the mean and standard deviation (SD) of all data, were calculated. The normality of variable distribution was assessed using the Kolmogorov-Smirnov test. Categorical variables were expressed as frequencies and percentages and analysed using appropriate statistical tests. To examine baseline differences prior to the main analysis, the Mann–Whitney U test was employed for non-parametric pre-intervention variables. For normally distributed data, a two-way repeated measures ANOVA (2 × 2) was conducted to assess group and time interactions. In cases of non-normally distributed data, between-group comparisons were performed using the Mann–Whitney U test, while within-group comparisons were assessed using the Wilcoxon signed-rank test. Percentage change (Δ%) was calculated to evaluate detailed variations at each time point. Effect sizes (η²) for the two groups were interpreted based on the thresholds proposed by Fritz et al. [ 33 ], with values < 0.10 considered small, 0.42 as medium, and 0.80 as large. The statistical significance level was set at p ≤ 0.05. Results Demographic and clinical factors’ characteristics A total of 60 participants were randomly assigned to either the sham CON (males, n = 15; females, n = 15) or the ITSS group (males, n = 16; females, n = 14). The mean age of all participants was 22.27 ± 1.80 years, with an average height of 165.16 ± 9.03 cm, body weight of 68.82 ± 13.94 kg, and BMI of 24.98 ± 3.11 kg/m². All participants had the average durations of nasal congestion and irregular sleep pattern of 3.39 ± 0.74 years and 3.01 ± 0.77 years. Prior to the experiment, there were no significant differences between the groups in terms of age, sex, height, body composition, smoking status, and alcohol consumption. No significant differences were found between the groups regarding the durations of nasal congestion and irregular sleep duration. The pre-experiment characteristics of the two groups are presented in Table 1 . Among the controlled variables, prior to the experiment, the dietary intake was 2252.67 ± 450.22 kcal for the CON and 2221.00 ± 388.29 kcal for the ITSS group, with no significant difference between the two groups (Z = − 0.477, p = 0.634, η² = 0.001). After the experiment, the dietary intake measured 2381.23 ± 353.09 kcal in the CON and 2350.93 ± 367.64 kcal in the ITSS group, again showing no significant difference (Z = − 0.624, p = 0.533, η² = 0.002). Similarly, before the experiment, the PA levels were 1814.23 ± 147.32 MET·min/ week for the CON and 1917.40 ± 235.82 MET·min/week for the ITSS group, with no significant difference (Z = − 1.648, p = 0.099, η² = 0.066). After the experiment, the PA levels were recorded as 1730.70 ± 243.92 MET·min/week in the CON and 1750.97 ± 226.39 MET·min/week in the ITSS group, also showing no significant difference (Z = − 0.022, p = 0.982, η² = 0.002). Influence of the ITSS intervention on subjectively felt nasal congestion and sleep state According to Table 2 , no significant difference was observed between the two groups in the perceived level of nasal congestion prior to the intervention. However, following the intervention, the CON exhibited an increase in perceived nasal congestion, whereas the ITSS group showed a decrease, yielding statistically significant differences between groups, within groups, and in the group-by-time interaction. The perceived sleep condition upon awakening showed no significant difference between the two groups before the intervention. Following the intervention, however, the CON demonstrated an increase in perceived sleep condition, while the ITSS group reported a decrease, leading to significant effects between groups, within groups, and in the interaction effect. As illustrated in Fig. 2 , changes in perceived nasal congestion and sleep condition following the intervention differed significantly between the groups. In the CON, nasal congestion increased by 11.92 ± 22.28%, whereas it decreased by -25.55 ± 28.74% in the ITSS group, showing a significant difference between the groups (Fig. 2 A). Similarly, subjective sleep condition increased by 18.88 ± 39.59% in the CON but declined by -24.22 ± 28.03% in the ITSS group, resulting in a statistically significant difference (Fig. 2 B). Influence of the ITSS intervention on respiratory capacity and BP As observed in Table 3 , there was no significant difference in resting respiratory rate between the two groups prior to the intervention. However, after the intervention, the resting respiratory rate increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. Similarly, no significant differences were observed between the groups in FEV₁ and PEF before the intervention. Following the intervention, however, both FEV₁ and PEF decreased in the CON but increased in the ITSS group, yielding statistically significant interaction effects. As further observed in Table 3 , there were no significant differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the groups before the intervention. However, after the intervention, SBP and DBP increased in the CON but decreased in the ITSS group, resulting in significant interaction effects. Table 3 Comparative results of respiratory capacity and blood pressure Groups (G) CON ITSS p (η²) Items Time (T) mean SD mean SD G T G×T Respiratory capacity rRR (reps/min) Pre 17.13 3.18 17.70 3.27 0.055 0.793 0.001 Post 18.90 2.43 15.67 4.05 (0.062) (0.001) (0.196) FEV₁ (L) Pre 3.20 0.68 3.26 0.75 0.031 0.212 0.001 Post 2.95 0.66 3.66 0.76 (0.078) (0.027) (0.320) PEF (L/s) Pre 4.08 1.24 4.05 0.73 0.061 0.002 0.001 Post 3.89 1.27 4.97 1.26 (0.059) (0.159) (0.298) Blood pressure level SBP (mmHg) Pre 131.47 11.04 132.77 10.03 0.053 0.835 0.001 Post 137.30 12.76 126.40 8.16 (0.063) (0.001) (0.283) DBP (mmHg) Pre 74.57 9.29 76.20 10.89 0.771 0.315 0.036 Post 75.77 9.03 72.87 7.63 (0.001) (0.017) (0.074) All data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; rRR, resting respiratory rate; FEV₁, forced expiratory volume in 1 sec; PEF, peak expiratory flow; SBP, systolic blood pressure; DBP, diastolic blood pressure. As illustrated in Fig. 3 , the changes in respiratory capacity and BP levels after the intervention revealed significant differences between the groups. The resting respiratory rate increased by 12.39 ± 16.70% in the CON, while it decreased by -8.64 ± 28.56% in the ITSS group, indicating a significant between-group difference (Fig. 3 A). Regarding pulmonary function, FEV₁ decreased by -6.98 ± 12.69% in the CON but increased by 14.29 ± 19.54% in the ITSS group (Fig. 3 B). Similarly, PEF declined by -3.99 ± 14.55% in the CON but rose by 23.80 ± 27.60% in the ITSS group (Fig. 3 C), both showing significant differences between the groups. As for BP, SBP increased by 4.58 ± 7.10% in the CON, whereas it decreased by -4.44 ± 7.38% in the ITSS group (Fig. 3 D). DBP increased by 2.11 ± 9.66% in the CON and by -3.35 ± 10.60% in the ITSS group (Fig. 3 E), both also showing significant differences between the groups. These findings suggest that the application of ITSS may have a beneficial effect on cardiopulmonary function. Influence of the ITSS intervention on HRV As shown in Table 4 , the HR, a time-domain index of HRV, did not differ significantly between the two groups before the intervention. However, after the intervention, HR increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. SDNN also showed no significant difference between the two groups prior to the intervention. After the intervention, both groups exhibited a decreasing trend, but the CON demonstrated a more pronounced decline compared to the ITSS group, leading to significant differences within groups and in the interaction effect. Meanwhile, RMSSD did not significantly differ between the groups before the intervention. After the intervention, however, RMSSD decreased in the CON and increased in the ITSS group, showing significant differences between groups and in the interaction effect. As further shown in Table 4 , the frequency-domain indices of HRV, namely LF and the LF/HF ratio, did not show significant differences between the two groups before the intervention. However, after the intervention, both LF and the LF/HF ratio increased in the CON but decreased in the ITSS group, resulting in significant between-group and interaction effects. Meanwhile, HF also showed no significant difference between the groups prior to the intervention. After the intervention, however, HF decreased in the CON and increased in the ITSS group, yielding statistically significant differences between groups, within groups, and in the interaction effect. Table 4 Comparative results of HRV Groups (G) CON ITSS p (η²) Items Time (T) mean SD mean SD G T G×T Time domain of heart rate variability HR (bpm) Pre 76.57 11.33 75.33 14.88 0.071 0.143 0.001 Post 79.00 10.25 69.83 9.44 (0.055) (0.037) (0.203) SDNN (ms) Pre 73.37 37.57 69.22 31.30 0.351 0.001 0.041 Post 41.69 14.05 56.63 24.76 (0.015) (0.291) (0.071) RMSSD (ms) Pre 35.53 10.98 36.53 11.99 0.013 0.665 0.001 Post 30.18 11.71 43.01 11.45 (0.103) (0.003) (0.267) Frequency domain of heart rate variability LF (ms²) Pre 657.17 98.57 663.17 109.65 0.031 0.315 0.001 Post 697.70 116.14 592.37 90.57 (0.078) (0.017) (0.194) HF (ms²) Pre 711.97 155.93 713.33 127.96 0.001 0.001 0.001 Post 543.37 163.60 771.07 104.90 (0.174) (0.187) (0.489) LF/HF ratio Pre 2.40 0.83 2.36 1.05 0.001 0.001 0.001 Post 2.70 0.79 0.78 0.17 (0.363) (0.372) (0.563) All data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; SDNN, standard deviation of NN intervals; RMSSD, root mean square of successive differences; LF, low frequency; HF, high frequency; ANS, autonomic nervous system. As illustrated in Fig. 4 , HR increased by 3.82 ± 8.67% in the CON but decreased by -5.83 ± 10.09% in the ITSS group, resulting in a significant difference (Fig. 4 A). Although SDNN decreased by -26.29 ± 49.35% in the CON and by -2.17 ± 56.74% in the ITSS group, this difference was not statistically significant (Fig. 4 B). In contrast, RMSSD declined by -13.38 ± 24.29% in the CON but increased by 25.75 ± 39.49% in the ITSS group, showing a significant difference between the groups (Fig. 4 C). LF power increased by 7.67 ± 19.22% in the CON and decreased by -9.15 ± 15.35% in the ITSS group, yielding a significant difference (Fig. 4 D). HF power decreased by -23.12 ± 15.30% in the CON but increased by 10.37 ± 18.19% in the ITSS group, also showing a significant difference (Fig. 4 E). Lastly, the LF/HF ratio rose by 18.47 ± 28.77% in the CON but dropped by -58.17 ± 22.02% in the ITSS group, resulting in a statistically significant difference (Fig. 4 F). Influence of the ITSS intervention on EEG factors As presented in Table 5 , following the intervention, the wide band mean increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. Although no statistically significant post-intervention differences were observed in delta, theta, beta, or other wave ratios, alpha power decreased in the CON but increased in the ITSS group, showing a significant interaction effect ( p = 0.023). Similarly, Gamma power showed a greater increase in the ITSS group compared to the CON after the intervention, indicating a significant interaction effect ( p = 0.038). Table 5 Comparative results of EEG factors Groups (G) CON ITSS p (η²) Waves/Power Time (T) mean SD mean SD G T G×T Wide band (µV²) Pre 29.16 12.08 30.33 9.29 0.112 0.852 0.001 Post 33.80 9.76 25.20 9.72 (0.043) (0.001) (0.192) Delta Pre 14.30 4.12 14.23 3.51 0.071 0.025 0.224 Post 10.61 3.85 13.11 6.90 (0.056) (0.084) (0.025) Theta Pre 14.85 5.81 13.86 6.27 0.466 0.957 0.106 Post 12.97 5.76 15.87 8.85 (0.009) (0.001) (0.045) Alpha Pre 11.38 4.15 10.46 4.21 0.835 0.673 0.023 Post 10.05 3.40 11.38 5.01 (0.001) (0.003) (0.086) Beta Pre 9.01 3.78 8.26 3.85 0.017 0.023 0.089 Post 12.05 4.86 8.72 4.74 (0.094) (0.086) (0.049) Gamma Pre 1.69 0.35 1.74 0.39 0.066 0.139 0.038 Post 1.65 0.30 1.98 0.71 (0.057) (0.037) (0.072) Alpha/Beta ratio Pre 1.01 0.46 1.06 0.42 0.705 0.634 0.364 Post 1.13 0.47 1.02 0.50 (0.002) (0.004) (0.014) Theta/Beta ratio Pre 1.66 0.36 1.65 0.31 0.209 0.612 0.301 Post 1.79 0.56 1.61 0.51 (0.027) (0.004) (0.018) All data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray. As shown in Fig. 5 , key changes in EEG components after the intervention demonstrated notable group differences. The wide band power increased by 24.90 ± 38.15% in the CON but decreased by -13.46 ± 33.19% in the ITSS group (Fig. 5 A). Alpha power declined by about − 3.81 ± 32.46% in the CON but increased by 14.90 ± 43.56% in the ITSS group (Fig. 5 D), and gamma power showed a slight increase of 0.20 ± 19.66% in the CON compared to a 13.71 ± 32.89% increase in the ITSS group (Fig. 5 F), all of which resulted in significant differences between the groups. Meanwhile, delta (Fig. 5 B), theta (Fig. 5 C), and beta powers (Fig. 5 E), as well as the ABR (Fig. 5 G) and TBR (Fig. 5 H), showed changes within each group after the intervention, but no significant differences were observed between the groups. Influence of the ITSS intervention on sleep factors As presented in Table 6 , the sleep quality component of the PSQI-K showed no significant difference between the two groups prior to the intervention. However, after the intervention, sleep quality increased in the CON but decreased in the ITSS group, indicating a significant interaction effect. Similar trends were observed in sleep latency, sleep duration, sleep efficiency, sleep disturbance, and daytime dysfunction, suggesting an overall improvement in sleep quality in the ITSS group. Accordingly, the sum scores of the PSQI-K significantly improved in the ITSS group compared to the CON. Table 6 Comparative results of PSQI-K factors between groups Groups (G) CON ITSS p (η²) Items Time (T) mean SD mean SD G T G×T Sleep quality Pre 2.07 0.58 2.10 0.55 0.001 0.015 0.001 Post 2.73 0.45 0.97 0.61 (0.526) (0.098) (0.617) Sleep latency Pre 3.03 1.13 3.10 1.37 0.005 0.183 0.001 Post 3.60 1.30 2.00 1.26 (0.129) (0.031) (0.234) Sleep duration Pre 1.70 0.60 1.67 0.66 0.028 0.556 0.001 Post 1.97 0.67 1.30 0.79 (0.081) (0.006) (0.195) Sleep efficiency Pre 2.10 0.84 2.13 0.68 0.001 0.001 0.001 Post 2.36 0.73 0.96 0.93 (0.246) (0.168) (0.333) Sleep disturbance Pre 2.17 0.70 2.23 0.57 0.001 0.002 0.001 Post 2.37 0.85 1.27 0.78 (0.176) (0.150) (0.291) Sleep medication Pre 0.13 0.43 0.17 0.53 1.000 0.155 0.155 Post 0.13 0.43 0.10 0.31 0.000 (0.034) (0.034) Daytime dysfunction Pre 2.37 0.81 2.40 0.72 0.001 0.006 0.001 Post 2.57 0.57 1.40 0.67 (0.301) (0.122) (0.239) Sum scores of PSQI-K Pre 11.50 1.46 11.70 2.26 0.001 0.001 0.001 Post 13.00 2.04 7.03 2.31 (0.453) (0.292) (0.608) All data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; PSQI, Pittsburgh Sleep Quality Index; VAS, visual analogue scale. As shown in Fig. 6 , sleep quality increased by 41.67 ± 43.71% in the CON, whereas it decreased by -48.33 ± 47.82% in the ITSS group (Fig. 6 A). Sleep latency also increased by 35.61 ± 84.19% in the CON but decreased by -21.78 ± 86.0% in the ITSS group, showing a significant difference (Fig. 6 B). Sleep duration (Fig. 6 C), sleep efficiency (Fig. 6 D), and sleep disturbance (Fig. 6 E) increased by 26.11 ± 55.48%, 56.11 ± 155.52%, and 24.44 ± 72.42%, respectively, in the CON, while decreasing by -25.0 ± 40.29%, -50.89 ± 55.16%, and − 44.45 ± 34.0% in the ITSS group, all indicating significant differences between the two groups. No notable changes were observed in the use of sleep medication (Fig. 6 F). However, daytime dysfunction increased by 35.0 ± 87.68% in the CON and decreased by -32.78 ± 41.40% in the ITSS group, revealing a statistically significant difference (Fig. 6 G). Finally, the total PSQI-K score increased by 14.64 ± 22.44% in the CON but decreased by -38.90 ± 21.99% in the ITSS group, resulting in a significant difference (Fig. 6 H). Discussion This study found that the ITSS technique, which uses moisture rather than medication, improved the nasal environment and provided a more comfortable sensation of nasal breathing by humidifying the nasal cavity. These effects contributed to improvements in both respiratory function and sleep condition. Notably, improved nasal environment was associated with stabilization of the ANS and enhanced relaxation, as evidenced by changes in Wide band, Alpha, and Gamma EEG activity in young adults with nasal congestion and irregular sleep patterns. These neurophysiological responses appear to contribute to the observed improvements in sleep quality. The nasal environment, including factors such as nasal cavity volume and resistance, plays a significant role in the transition from wakefulness to sleep. Just as individuals maintain various postures—such as sitting, reclining, or standing—while awake, they also adopt different positions during sleep. These postural changes, along with stressors or neurological factors that may occur during the day, can influence nasal cavity volume and, consequently, affect sleep quality. In this context, an epidemiological study by Young et al. [ 34 ] identified nasal congestion as a risk factor for sleep-disordered breathing. In a subsequent population-based cohort study with a five-year follow-up [ 35 ], chronic nocturnal nasal congestion was found to be a significant risk factor for habitual snoring (odds ratio 4.9). Moreover, individuals with allergy-induced nasal congestion had a 1.8-fold increased risk of developing moderate-to-severe sleep-disordered breathing compared to those without allergic congestion. Beyond epidemiological findings demonstrating the association between nasal congestion and sleep disorders, several laboratory studies have provided experimental evidence for this relationship. Eckert and Younes [ 36 ] experimentally induced nasal obstruction and demonstrated an increase in both sleep apnea and electroencephalographic arousals during sleep. Similarly, Fitzpatrick et al. [ 37 ] showed that modulating nasal resistance using irritants led to the induction of apnea and hypopnea during sleep. Taken together, the existing body of research suggests that nasal congestion—regardless of its underlying cause—can be considered a contributing factor to the development of sleep problems. Even within the present study, among the 60 participants, the average duration of nasal congestion was 3.39 ± 0.74 years, while the duration of sleep irregularity associated with sleep disturbances was 3.01 ± 0.77 years. These findings suggest a potential relationship between nasal congestion—such as that caused by rhinitis—and sleep-related problems. Considering that the participants were in their early to mid-20s, this association may indicate the potential for more serious consequences later in life. Although not addressed as a primary outcome in this study, the correlation between nasal congestion and irregular sleep patterns was examined, revealing a statistically significant association (r = 0.308, p = 0.017), suggesting a clear link between nasal congestion and sleep patterns. Additionally, prior to the intervention, the average severity of nasal congestion assessed by VAS among the sixty participants was 4.87 ± 0.97, while the perceived severity of sleep-related problems was 4.71 ± 1.64. These findings further support the notion that nasal congestion is closely associated with subjective sleep difficulties. Although no model has directly explained or demonstrated that changes in nasal resistance can induce sleep problems, considering the Starling resistor model in relation to nasal resistance provides a possible explanation. If a narrowed region within the nasal cavity or any other cause leads to increased nasal resistance, negative pressure may develop downstream of the affected area. This negative pressure could contribute to the collapse of the oropharyngeal region, which lacks skeletal support [ 38 ]. Furthermore, during sleep, the muscles comprising the oropharyngeal region are in a more relaxed state compared to wakefulness, making them more susceptible to collapse due to negative pressure [ 39 ]. To date, numerous studies have reported that treating nasal congestion can improve the quality of life in patients with sleep problems. Li et al. [ 40 ] reported an improvement in patients' quality of life following nasal surgery. Similarly, Miyazaki et al. [ 41 ] conducted a study on 54 obstructive sleep apnea patients using a catheter-based pressure transducer to examine the relationship between nasal congestion and obstructive sleep apnea. Their findings suggested that while nasal congestion itself may not be a primary cause of obstructive sleep apnea, it can act as a contributing factor. Additionally, Löth et al. [ 42 ] demonstrated that the use of a nostril dilator increased nasal breathing in snoring patients, leading to improved quality of life. Recently, the ITSS device, developed to alleviate nasal congestion, has been reported to help relieve congestion by delivering warm water to the nasal cavity using jet stream wet technology [ 14 ]. However, the underlying mechanisms through which ITSS influences sleep quality remain largely unexplored. Specifically, how ITSS improves respiratory function by enhancing nasal hydration and the perception of nasal openness—and how these changes subsequently affect the ANS, brain activity, and ultimately sleep patterns—has not yet been fully investigated. To address this, the present study investigated the effects of ITSS treatment over an eight-week period. The results showed that nasal congestion severity, as assessed by the VAS, increased by approximately 12% in the CON, whereas the ITSS group experienced a 26% reduction following ITSS treatment (Z = − 4.576, p < 0.001). Similarly, sleep condition worsened by around 19% in the CON but improved by about 24% in the ITSS group (Z = − 3.899, p < 0.001). These improvements were also reflected in respiratory function: the resting respiratory rate increased by approximately 12% in the CON, whereas it decreased by nearly 9% in the ITSS group (Z = − 3.506, p < 0.001). Furthermore, while FEV₁ and PEF showed minimal change or slight decreases in the CON, the ITSS group demonstrated significant increases of about 14% (Z = − 4.274, p < 0.001) and 24% (Z = − 3.963, p < 0.001), respectively, suggesting that the improvement in nasal congestion contributed to enhanced respiratory function. This improvement in respiratory function appeared to contribute to reductions in BP, as evidenced by ANS markers in the ITSS group. Specifically, a decrease in SDNN and an increase in RMSSD were observed, indicating a shift toward parasympathetic nervous dominance. Moreover, HF power, which reflects parasympathetic nervous activity, decreased by approximately 23% in the CON but increased by around 10% in the ITSS group. In contrast, the LF/HF ratio, representing sympathetic nervous activity, increased by about 18% in the CON but decreased by nearly 58% in the ITSS group. These results suggest that the ITSS intervention may have facilitated ANS stabilization and contributed to improved BP regulation. To date, no research has directly examined the effects of intranasal steam spray on nasal congestion relief and brain wave changes during sleep or daytime activities such as working. However, a substantial body of literature has investigated the relationship between nasal congestion, sleep quality, and brain wave activity. Understanding these connections is crucial, as nasal congestion can significantly impact sleep architecture, cognitive function, and overall well-being. Several studies have explored the effects of improving nasal environment on brain wave characteristics and sleep patterns. Walsh et al. [ 43 ] reported that nasal expansion led to an increase in delta wave activity, which is closely associated with deep sleep and physical recovery. Delta waves (0.5–4 Hz) play a fundamental role in restorative sleep, facilitating tissue repair, immune function, and overall physiological recovery [ 44 ]. The enhancement of delta wave activity suggests that nasal expansion could contribute to improved sleep quality and physical restoration. According to the EEG analysis in this study, the delta wave increased by nearly 3.23% in the ITSS group, whereas it significantly decreased by approximately 11% in the sham CON ( p = 0.025). This trend appears to be consistent with previous studies; however, no significant interaction effect was observed. Therefore, further in-depth investigations are warranted to elucidate the specific mechanisms underlying these changes. This suggests that intranasal steam spray may help regulate sleep-related brain activity by increasing body temperature and alleviating nasal congestion to some extent. This trend is further supported by the findings in the ITSS group, where alpha wave, related to relaxation and a calm mental state, improved by around 15% after the ITSS intervention (interaction effect p = 0.023). Moreover, gamma wave, which is closely linked to stress, anxiety, and cognitive processing, increased by around 14% (interaction effect p = 0.038). Meanwhile, wide band mean power typically ranges between 20–40 µV² in a normal resting state. In this study, the CON showed a 25% increase from 29.16 ± 12.08 µV² at baseline to 33.80 ± 9.76 µV² post-intervention, indicating a shift toward a heightened arousal state. In contrast, the ITSS group exhibited a 13% decrease from 30.33 ± 9.29 µV² to 25.20 ± 9.72 µV², suggesting a transition toward a more relaxed physiological state. These results suggest that ITSS may help reduce psychological stress and alleviate mental tension by moistening and expanding the nasal passages. In relation to this, several previous studies have indicated that theta wave plays a crucial role in the transition between wakefulness and sleep, supporting memory processing and emotional regulation [ 45 ]. In other words, an increase in theta wave activity suggests that nasal expansion may facilitate smoother sleep transitions and enhance cognitive processing during sleep. Additionally, alpha wave, which is associated with relaxation, meditation, and the transition to sleep, has been shown to increase after nasal expansion. Since alpha wave activity is often linked to a state of wakeful rest and is considered essential for initiating sleep [ 46 , 47 ], the observed increase in alpha wave in this study indicates that nasal expansion promotes psychological relaxation and prepares the brain for sleep onset. Furthermore, the findings align with the study by Hammer et al. [ 48 ], which reported that gamma wave—frequently activated during REM sleep and associated with high-order cognitive functions such as emotional regulation and problem-solving—increased with nasal expansion. In this study, beta wave activity showed a notable increase in the CON, whereas a relatively smaller increase was observed in the ITSS group. This pattern may suggest that the ITSS group experienced a more stable and calmer psychological state. Supporting this, Pei et al. [ 45 ] reported that reduced beta wave, resulting from nasal expansion, contributes to a more relaxed physiological state, potentially mitigating hyperarousal that can hinder sleep onset and maintenance. Similarly, some of research noted that beta activity plays a critical role in motor and sensory regulation, as well as in stabilizing and maintaining sleep by ensuring efficient neural communication during sleep [ 49 ]. Ultimately, improved nasal condition induced by ITSS may positively influence beta wave, which is associated with physical stability and improved concentration. However, as both groups in the present study showed increased beta waves with no statistically significant interaction effect, further research is warranted to better understand the underlying mechanisms. To our knowledge, no studies have directly examined the effects of ITSS on nasal congestion relief and PSQI. However, it is well known that nasal congestion negatively affects sleep quality, and various nasal sprays have been reported to help alleviate this issue. In other words, nasal congestion can cause breathing difficulties during sleep, leading to a decline in sleep condition and quality, which may be reflected in an increased PSQI score. For example, saline sprays are commonly used to rinse the nasal passages, remove allergens, and alleviate dryness inside the nasal cavity [ 50 , 51 ]. Hermelingmeier et al. [ 52 ] highlighted that intranasal saline therapy is a safe, cost-effective, and efficient treatment, as it helps remove mucus, accumulated secretions, and inflammatory cytokines from the nasal passages. Similarly, Fokkens et al. [ 53 ] reported that it supports mucociliary clearance and reduces mucosal swelling. As a result, intranasal saline therapy is widely recommended as an adjunct treatment for sinonasal conditions such as rhinosinusitis, rhinitis, and upper respiratory tract infections. The intranasal steam spray used in this study introduces 43°C water into the nasal cavity, promoting nasal expansion and increasing cranial temperature, which may help induce sleep. Notably, the results of this study showed that the “sleep quality” score on the PSQI-K improved by approximately 48% following ITSS intervention, whereas the sham CON exhibited a deterioration of about 42%. Moreover, in terms of sleep latency—the time taken to fall asleep—the CON showed an increase of approximately 36% after the intervention, whereas the ITSS group exhibited a decreasing trend of about 22%, approaching the critical threshold of falling asleep within 30 min. In addition, regarding the PSQI-K subscales—“sleep duration,” “sleep efficiency” (the ratio of actual sleep time to time spent in bed), “sleep disturbances,” and “daytime dysfunction” (reflecting the impact of sleepiness and fatigue on daily activities)—the placebo-controlled group showed an increasing trend after the intervention, whereas the ITSS group exhibited significant reductions, indicating an interaction effect. Consequently, the total PSQI-K score related to sleep quality increased by approximately 15% in the CON but decreased by 39% in the ITSS group, approaching the threshold score of 7. Considering the PSQI-K criteria established by Sohn et al. [ 32 ], where a score of 8.5 or lower indicates good sleep quality and a score above 8.5 indicates poor sleep quality, these findings strongly suggest that intranasal thermal steam spray has a highly positive impact on sleep quality. Meanwhile, a study using the NOZOVENT nasal dilator in 15 individuals with non-pathological nasal structures reported no significant changes in apnea–hypopnea events or oxygen saturation, with only a limited reduction in snoring episodes during slow-wave sleep [ 54 ]. Consistently, a systematic review found that most studies reported no improvement in AHI with external nasal dilators, while minor improvements were observed only with certain internal dilators [ 55 ]. Taken together, these findings highlight that the effects of nasal dilators on objective sleep parameters remain limited, and further research is warranted to clarify their clinical significance. In addition, although this study conducted a scientifically calculated sample size estimation and recruited participants accordingly as part of a clinical trial to evaluate the intervention's effectiveness, the overall sample size may still be considered relatively small. Since this study aimed to investigate the impact of ITSS treatment on changes in physiological and psychological variables related to nasal environment improvement, further detailed and long-term studies are recommended. Additionally, as the study participants were adults in their 20s experiencing nasal congestion and sleep disturbances, further research involving a more diverse population, including various patient groups, is encouraged. Conclusions This study concluded that the application of ITSS enhanced the nasal environment—particularly by alleviating the sensation of nasal congestion—which in turn led to favourable changes in cardiopulmonary function. These physiological improvements may further contribute to better sleep quality by promoting ANS balance and stabilizing brain activity. Declarations Financial support : This work was not supported by external organ. Trial registration : The study was retrospectively registered on April 3, 2025, in the Clinical Research Information Service (https://cris.nih.go.kr/cris/search/listDetail.do/) under registration number KCT0010381. Acknowledgements We sincerely thank all the patients who permitted us to use their data for this study. Authors’ contributions Jaehoon Kim: conceptualization, methodology, project administration, writing – review and editing, resources. Jaehoon Hwang: conceptualization, funding acquisition, methodology, validation, resources. Kyungryul Chung: conceptualization, validation, writing – review and editing, resources. Youngsoo Jin: methodology, validation, writing – review and editing, resources. Yong-Seok Jee: conceptualization, data curation, formal analysis, writing – original draft, writing – review and editing, validation, methodology, resources. All the authors provided critical feedback and helped shape the research, analysis, and manuscript. All the authors have read and agreed to the published version of the manuscript. Funding This work was not supported by external organ. Data availability Data is provided within the manuscript or supplementary information files. Ethics approval and consent to participate The researchers followed the principles outlined in the Declaration of Helsinki. This study adhered to ethical guidelines, with all participants providing informed consent after being fully informed of the study’s purpose and procedures. Confidentiality was maintained, and participants could withdraw at any time. They were also offered access to the study’s results if requested. The Ethics Committee of Hanseo University (HS24-12-18) approved this study, and the study was retrospectively registered on April 3, 2025, in the Clinical Research Information Service under registration number KCT0010381. Consent for publication Not applicable. Conflict of interest The authors have no competing interest in reporting. 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A daily nasal spray with saline prevents symptoms of rhinitis. Acta Otolaryngol. 2004;124(9):1059–62. Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2012;26(5):e119–25. Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1–464. Hoffstein V, Mateika S, Metes A. Effect of nasal dilation on snoring and apneas during different stages of sleep. Sleep. 1993;16(4):360–5. Camacho M, Malu OO, Kram YA, Nigam G, Riaz M, Song SA, Tolisano AM, Kushida CA. Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis. Pulm Med. 2016;2016:4841310. Additional Declarations No competing interests reported. Supplementary Files CONSORT2025editablechecklist.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers agreed at journal 14 Sep, 2025 Reviewers invited by journal 04 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 14 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 14 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7253632","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512617707,"identity":"f61d298f-814b-4f09-bfd6-b7dee10ee269","order_by":0,"name":"Jaehoon Kim","email":"","orcid":"","institution":"Korea Sleep Industry Association","correspondingAuthor":false,"prefix":"","firstName":"Jaehoon","middleName":"","lastName":"Kim","suffix":""},{"id":512617708,"identity":"345bc92b-166b-4e92-bc52-b8e3a8d710f0","order_by":1,"name":"Jaehoon Hwang","email":"","orcid":"","institution":"Korea Sleep Industry Association","correspondingAuthor":false,"prefix":"","firstName":"Jaehoon","middleName":"","lastName":"Hwang","suffix":""},{"id":512617709,"identity":"b65e042a-7eea-48cc-bf59-333d832582a7","order_by":2,"name":"Kyungryul Chung","email":"","orcid":"","institution":"Korea Sleep Industry Association","correspondingAuthor":false,"prefix":"","firstName":"Kyungryul","middleName":"","lastName":"Chung","suffix":""},{"id":512617710,"identity":"e77e6b4c-bfe9-4abb-9043-5bf33836593b","order_by":3,"name":"Youngsoo Jin","email":"","orcid":"","institution":"Korea Sleep Industry Association","correspondingAuthor":false,"prefix":"","firstName":"Youngsoo","middleName":"","lastName":"Jin","suffix":""},{"id":512617711,"identity":"116de3ff-06c5-41b7-bba7-f2787e696c36","order_by":4,"name":"Yong-Seok Jee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACxgYQWXEAISJBnJYzpGiB6GsjRQtze/MxyZ/z7sib8x8++IChxo5BcvYB/FoYe46lSfNue2a4c0ZasgHDsWQGab4EAlpm5JhJM247zLjhBo+ZBAPbAQY5HgIOY5z//pvkzzmH7TecP/9NguEfMVpm8LBJ8DYcTtxwIIdNAhQO0gS19KQZW/McO5y84UaasUFiXzKPZA8BLYbthx/e/FFz2HbD+cMPH3z4ZicncYaQlgYGFkRMJDAwEHIWA4M8MGo+EFQ1CkbBKBgFIxsAAOWgQxivHjDkAAAAAElFTkSuQmCC","orcid":"","institution":"Korea Sleep Industry Association","correspondingAuthor":true,"prefix":"","firstName":"Yong-Seok","middleName":"","lastName":"Jee","suffix":""}],"badges":[],"createdAt":"2025-07-30 13:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7253632/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7253632/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91093492,"identity":"af2f6b62-0967-467a-ab5a-276ec36e2fa7","added_by":"auto","created_at":"2025-09-11 13:39:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":126399,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/61447c5aca868101cd8e572d.png"},{"id":91094016,"identity":"c2f07424-4f6e-41a5-9dd4-425dc4cd1cb2","added_by":"auto","created_at":"2025-09-11 13:47:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57222,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences of Δ%\u003cstrong\u003e \u003c/strong\u003ein perceived nasal congestion and sleep condition. CON, control group; ITSS, intranasal thermal steam spray group.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e****\u003c/sup\u003e indicates \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001 between groups.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/ec910ce9719e592bda8c7048.png"},{"id":91093496,"identity":"3d67eb3d-e9a9-4e30-a0fc-f8b983ee07e1","added_by":"auto","created_at":"2025-09-11 13:39:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":127584,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences of Δ% in respiration capacity and BP levels.\u003c/p\u003e\n\u003cp\u003eCON, control group; ITSS, intranasal thermal steam spray group; FEV₁, forced expiratory volume in 1 sec; PEF, peak expiratory flow; SBP, systolic blood pressure; DBP, diastolic blood pressure.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003e*, ***,\u003c/sup\u003e and\u003csup\u003e ****\u003c/sup\u003e indicates \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05,\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.001 , and\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.0001 between groups.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/84caee1e223f81e7aae225f2.png"},{"id":91093501,"identity":"f13397df-367a-40ec-8ba6-5d2889ac0c60","added_by":"auto","created_at":"2025-09-11 13:39:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":206064,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences of Δ% in heart rate variability of time and frequency domains.\u003c/p\u003e\n\u003cp\u003eCON, control group; ITSS, intranasal thermal steam spray group; SDNN, standard deviation of NN intervals; RMSSD, root mean square of successive differences; LF, low frequency; HF, high frequency.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ens, ***,\u003c/sup\u003e and\u003csup\u003e ****\u003c/sup\u003e indicate \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05,\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.001 , and\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.0001 between groups.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/42fe058579010c78a7ef6c58.png"},{"id":91093491,"identity":"0e0192dc-1e0a-4e6e-b783-954648b27991","added_by":"auto","created_at":"2025-09-11 13:39:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":139851,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences of Δ% in electroencephalogram factors.\u003c/p\u003e\n\u003cp\u003eCON, control group; ITSS, intranasal thermal steam spray group.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ens, *, \u003c/sup\u003eand\u003csup\u003e ***\u003c/sup\u003e indicate \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05,\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.05 , and\u003cem\u003e p\u003c/em\u003e \u0026lt; 0.001 between groups.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/e16ba24e86ec24c36edc56d2.png"},{"id":91093490,"identity":"0021b612-b96c-48f0-a86c-a4a475651b0c","added_by":"auto","created_at":"2025-09-11 13:39:03","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":127150,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences of Δ% in PSQI-K.\u003c/p\u003e\n\u003cp\u003eCON, control group; ITSS, intranasal thermal steam spray group.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*, ***,\u003c/sup\u003e and\u003csup\u003e ****\u003c/sup\u003e indicate \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, and \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001 between groups.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/0f6c464fb3ab60f40ed7f865.png"},{"id":91094960,"identity":"7acf616d-ecd7-4c7d-9bd8-0a194d57e97b","added_by":"auto","created_at":"2025-09-11 13:55:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1915120,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/7b78d64c-102d-44fe-99c7-98062e1e5c88.pdf"},{"id":91093493,"identity":"26922f3f-722a-4d14-afbf-c7876e0a2cb6","added_by":"auto","created_at":"2025-09-11 13:39:04","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":45353,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2025editablechecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7253632/v1/f05088128fa71b4e288524a7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A randomized controlled trial investigating the effect of thermal steam spray on nasal condition, neurological function, and sleep quality in young adults with nasal congestion and irregular sleep patterns","fulltext":[{"header":"Background","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eRespiration is an essential life-sustaining activity that delivers oxygen to all cells of the human body, enabling normal physiological functions. While breathing can occur through both the nasal and oral cavities, the nose is the primary organ responsible for respiratory capacity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The respiratory system comprises from nasal cavity to lungs, facilitating oxygen intake through the nasal passages and its circulation throughout the body via alveoli in the lungs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For efficient respiration, the intranasal airway must remain unobstructed [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, various conditions such as nasal septal deviation, colds, sinusitis, and allergic rhinitis can lead to nasal congestion or obstruction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Nasal congestion including abnormal rhinitis or can compromise nasal respiratory function, thereby disrupting the sleep\u0026ndash;wake cycle [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Such impairment has been associated with various sleep disorders, including insomnia, hypersomnia, and so on [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Irregular sleep patterns\u0026mdash;especially those linked to nasal dysfunction\u0026mdash;have been shown to impair respiratory function and are further associated with elevated stress levels, increased fatigue, and declines even in cognitive performance and concentration [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Ultimately, maintaining an optimal intranasal airway is a crucial factor in ensuring a high quality of life and overall health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies addressing the management of intranasal conditions have proposed a range of interventions, including pharmacological therapies (e.g., antihistamines, intranasal corticosteroids), surgical procedures (e.g., septoplasty, turbinate reduction), and conservative treatment approaches (e.g., nasal irrigation, steam inhalation) [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, although various therapeutic strategies exist to improve the intranasal environment, surgical interventions often entail significant economic burden, while pharmacological treatments may lead to adverse side effects [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, conservative approaches frequently require complex preparation, contributing to practical inconvenience, further highlighting the need for more effective and safer solutions aimed at relieving intranasal congestion to improve sleep quality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Recently, an intranasal thermal steam spray (ITSS) device has been developed and is gaining attention for its effectiveness in alleviating intranasal congestion while ensuring biocompatibility. This home healthcare device operates by delivering 43\u0026deg;C moisture steam into the intranasal cavity, providing a safe and efficient solution for nasal congestion or obstruction [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, despite its demonstrated effectiveness in alleviating intranasal congestion, no studies to date have explored its potential impact on respiratory capacity and sleep quality. In particular, there is a significant lack of research investigating whether the flow of air circulating through an optimal respiratory pathway influences the autonomic nervous system (ANS) regulation and, in turn, affects stable brain activity. Therefore, the present study aimed to investigate the potential benefits of ITSS in improving the intranasal wet environment and its consequent effects on respiratory capacity, ANS function and brain activity. Furthermore, this study sought to determine whether these effects translate into measurable improvements in sleep quality.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study was designed as a randomized, double-blinded, sham-controlled trial. Following approval by the Hanseo University Institutional Review Board (HS24-12-18), the study investigated the efficacy of ITSS through an interventional approach. Participants underwent an eight-week ITSS intervention (April 7, 2025 to June 2, 2025), followed by assessments and analyses of its impact on subjective nasal congestion, perceived sleep condition, respiratory performance, neurological function including ANS and brain activities, and overall sleep quality. This study obtained written informed consent in accordance with the Declaration of Helsinki [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and was retrospectively registered on ClinicalTrials.gov under the identifier KCT0010381 on April 3, 2025. This study adhered to the CONSORT guidelines published in 2025 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and the completed checklist is provided in the supplementary materials (Supplementary Table\u0026nbsp;1).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe participants were male and female university students aged between 20 and 26 years, residing in two dormitories on the same university campus. They expressed interest in the study after viewing a social media advertisement related to the research, reporting symptoms of nasal congestion and sleep disturbances. Participants were instructed to carry out their daily activities and meals within their assigned dormitories and were asked not to disclose their involvement in the study to others. The inclusion criteria for this study required participants to exhibit symptoms such as clear nasal discharge, sneezing, nasal congestion, and nasal itching, along with irregular sleep patterns. Participants were assessed to determine whether their symptoms were occasional or persistent and to identify periods of symptom exacerbation. Subsequently, an otolaryngologist conducted a diagnostic evaluation for rhinitis, including nasal examination and nasal secretion analysis. Meanwhile, individuals diagnosed with congenital nasal obstruction, such as congenital pyriform aperture stenosis, or those with chronic diseases affecting the heart, lungs, or other major organs were excluded from this study. Additionally, individuals who had been regularly participating in an exercise program for more than six months, were heavy smokers, engaged in high-risk alcohol consumption as defined by the WHO, or had metabolic syndrome were also excluded [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Individuals with a prior diagnosis of cardiovascular or cerebrovascular disease, cancer, or psychiatric conditions were likewise excluded from the study.\u003c/p\u003e\u003cp\u003eThe sample size was determined via G*Power (ver.3.1.9.7; Heinrich-Heine-Universit\u0026auml;t, D\u0026uuml;sseldorf, Germany), with assumptions including an effect size of f\u0026sup2;(\u003cem\u003eV\u003c/em\u003e)\u0026thinsp;=\u0026thinsp;0.25, an α error probability of 0.05, a power of 0.95, two groups, and two measurements [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The minimum required sample size was 54 participants. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 68 participants were recruited; however, 4 were excluded because they failed to meet the inclusion criteria or for personal reasons. Among the remaining 64 participants who completed the demographic survey and baseline assessment, random tags were used to assign one facility to the control group (CON) and another facility to the ITSS group. The principal investigator carried out all these procedures. A total of 32 participants were assigned to the CON at one facility, while another 32 participants were allocated to the ITSS group at a separate facility. During the eight-week program, two participants from the CON and two participants from the ITSS group dropped out during the follow-up stage. No participants from either group were excluded during the analysis, resulting in a final sample of 30 participants in each group: the CON and the ITSS group. Standardized guidelines were implemented for pre- and post-assessments to ensure strict blinding throughout the study.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eITSS intervension program\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAn intranasal vapor spray device (RhinoCare Korea Inc., Gumi, Korea) is a medical device certified by the Ministry of Food and Drug Safety for the treatment of nasal congestion caused by rhinitis, sinusitis, colds, and flu. This device facilitates breathing by utilizing Jet Stream technology (80 mmH₂O), which delivers 43\u0026deg;C vapor heat to the intranasal cavity through an internal heating mechanism, and its effectiveness has been recognized. Additionally, it has met safety standards for medical devices, including the residual wave test, as verified by an authorized testing agency [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Participants in the ITSS group were instructed to use the device for 15 min, three times per week, for eight weeks, activating it 30 min before bedtime. Meanwhile, participants in the CON were provided with the device without vapor heat emission and were instructed to use it under the same conditions as the ITSS group.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eAnthropometric data\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAnthropometric measurements were conducted on the first and final days of the intervention between 7:00 a.m. and 8:00 a.m., prior to breakfast. To ensure measurement accuracy, assessments were primarily performed on participants who had refrained from fluid intake and had completed both urination and defecation beforehand. Height was measured using an automated stadiometer while participants wore lightweight gowns. Body weight, fat mass, and muscle mass were assessed using the InBody 720 device (BioSpace, Seoul, Korea) with participants standing after a 10-hour fasting period. Body mass index (BMI) was also calculated based on the weight-to-height ratio.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical data\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo monitor external variables, participants were asked to complete a questionnaire between 9:00 p.m. and 10:00 p.m. each night prior to sleep, recording dietary intake and daily activities. In addition, between 7:00 a.m. and 8:00 a.m. each morning, the degree of subjective nasal openness and perceived post-sleep condition were assessed using a visual analogue scale (VAS). First, all participants in both groups consumed three meals per day, prepared under the supervision of a certified nutritionist. The daily caloric intake was set at 2,400\u0026ndash;2,700 kcal, with a predominantly plant-based dietary regimen. To ensure accuracy and adherence, a researcher recorded participants\u0026rsquo; daily dietary intake using CAN-Pro 5.0 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://canpro5.kns.or.kr\u003c/span\u003e\u003cspan address=\"http://canpro5.kns.or.kr\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; Korean Nutrition Society). Second, physical activity (PA) levels were assessed using the International PA Questionnaire-Short Form [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Third, all participants were instructed to evaluate the subjectively felt degree of nasal congestion and their post-sleep condition each morning upon waking, using a VAS-based recording sheet delivered via direct message. The perceived degree of nasal dilatation was determined using a VAS [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The left end of a 10 cm long line was placed as \u0026lsquo;open nasal cavity (0)\u0026rsquo; and the right end was placed as \u0026lsquo;blocked nasal cavity (10)\u0026rsquo;, and they were asked to mark the degree of nasal congestion they felt. A quantitative test of post-sleep condition was also conducted using the VAS. The left end of a 10 cm long line was placed as \u0026lsquo;no discomfort with sleep (0)\u0026rsquo; and \u0026lsquo;severe discomfort with sleep (10)\u0026rsquo;, and they were asked to mark the sleep problems he or she felt. These clinical data were continuously monitored throughout the entire duration of the intervention period. The collected data were analysed on a weekly and monthly basis.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRespiratory capacity, blood pressure and heart rate variability\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eRespiratory capacity, blood pressure (BP), and heart rate variability (HRV) used to assess ANS function was measured between 7:00 a.m. and 8:00 a.m. on the first and final days of the intervention. First, resting respiratory rate was assessed by observing chest movement while participants lay in a supine position on a bed for 60 sec. Subsequently, pulmonary function was evaluated using a Spirovit SP-1 spirometer (SCHILLER AG, Switzerland). Key respiratory variables measured included forced expiratory volume in one second (FEV₁) and peak expiratory flow (PEF). For testing, participants wore a nasal clip to prevent air leakage and inserted a disposable mouthpiece into their mouths. They were instructed to exhale forcefully through the mouth following a maximal inhalation to measure the targeted respiratory parameters. Prior to the actual data collection, participants underwent practice sessions to familiarize themselves with the spirometry technique. Each participant performed the test three times, and the highest value recorded among the trials was used for statistical analysis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Second, resting BP was measured using an automated sphygmomanometer. For the assessment, an appropriately sized cuff was placed on the brachial artery of the right arm. Third, to assess ANS activity, HRV was measured using the uBiomacpa device (Biosensecreative Co. Ltd. Seoul, Korea). Participants were instructed to refrain from exercise and alcohol consumption the day before the assessment, and to avoid food or caffeine intake for at least three hours prior to testing. HRV measurements were taken twice on the day of the experiment, and the average values were used for analysis [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During the measurement, participants sat comfortably for 2\u0026ndash;3 min while pulse waves were non-invasively recorded via a sensor attached to the index finger. To ensure data reliability, participants were advised to remain still and avoid talking, coughing, or deep breathing during the procedure. The analysis included both time-domain measures and frequency-domain parameters derived from power spectral density estimates using autoregressive modeling [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In time-domain analysis, HRV is assessed by measuring the intervals between successive normal QRS complexes, referred to as normal-to-normal (NN) intervals. Two key time-domain metrics are used: the standard deviation of NN intervals (SDNN), which reflects overall HRV by capturing all cyclic components, and the root mean square of successive differences between NN intervals (RMSSD), which primarily reflects parasympathetic activity. In contrast, frequency-domain analysis examines the spectral components of HRV. This includes low-frequency (LF) and high-frequency (HF) bands, which are associated with sympathetic and parasympathetic nervous system activity, respectively. The LF/HF ratio, calculated from normalized LF and HF values, served as an index of sympathetic modulation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. To enhance data accuracy, the first hour of recording was excluded from analysis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and any transient noise or movement artifacts were manually removed.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eElectroencephalogram data measures\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eElectroencephalography (EEG) recordings were conducted between 7:00 a.m. and 8:00 a.m. on both the first and final days of the intervention period. Prior to EEG acquisition, participants underwent a 10-min resting period in a quiet and thermally controlled indoor environment to ensure physiological stabilization. Subsequently, resting EEG was recorded for 5 min while participants remained seated in a relaxed posture with their eyes gently closed [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. EEG data were acquired using a 10-channel wired EEG system (Neurofeedback Intermediate System, Montreal, Quebec, Canada). Scalp electrodes were affixed according to the international 10\u0026ndash;20 system, targeting the frontal (F3, F4, Fz), temporal (T3, T4), parietal (P3, P4), and central regions. Reference electrodes were attached via ear clips on both earlobes. The sampling rate was configured at 500 Hz. Signal preprocessing included the application of a 60 Hz notch filter to remove power line interference and a bandpass filter to attenuate low- and high-frequency noise. Ocular artifacts, such as eye blinks, were eliminated using Independent Component Analysis. Power spectral analysis was subsequently performed using Fast Fourier Transform, yielding absolute and relative power values across predefined frequency bands. To investigate the potential effects of nasal congestion on alterations in sleep-related EEG patterns, spectral power was examined across the entire brain in the wide band range and within specific frequency domains: delta (0.5\u0026ndash;4 Hz; relative power: 0\u0026ndash;20%), theta (4\u0026ndash;8 Hz; 5\u0026ndash;20%), alpha (8\u0026ndash;12 Hz; 20\u0026ndash;40%), beta (13\u0026ndash;30 Hz; 10\u0026ndash;30%), and gamma (\u0026gt;\u0026thinsp;30 Hz; 3\u0026ndash;10%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, to enable a more refined assessment of neural activity, the alpha / beta ratio (ABR) and theta / beta ratio (TBR) were computed and analyzed.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSleep quality measures\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe Pittsburgh Sleep Quality Index (PSQI) is a standardized self-report questionnaire designed to assess sleep quality and patterns over the past month. It is widely utilized in clinical and research settings to evaluate sleep disturbances and insomnia. Originally developed by Buysse et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the PSQI has been adapted into various languages, including Korean. This study employed the Korean version of the PSQI (PSQI-K), which comprises 18 items across seven domains: subjective sleep quality (1 item), sleep latency (2 items), sleep duration (1 item), sleep efficiency (2 items), sleep disturbances (9 items), use of sleep medication (1 item), and daytime dysfunction (2 items). The PSQI-K has demonstrated high reliability, with a Cronbach\u0026rsquo;s α of 0.779. Each domain is scored on a scale of 0 to 3, yielding a total score ranging from 0 to 21, where higher scores indicate poorer sleep quality. In this study, sleep quality was classified based on the criteria established by Shon et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A PSQI-K total score of 8.5 points or lower was categorized as \"good sleep quality,\" while a score exceeding 8.5 points was classified as \"poor sleep quality.\"\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eStatistical analyses were performed using GraphPad Prism 10.4.1 software (GraphPad Software, Boston, MA, USA). Descriptive statistics, including the mean and standard deviation (SD) of all data, were calculated. The normality of variable distribution was assessed using the Kolmogorov-Smirnov test. Categorical variables were expressed as frequencies and percentages and analysed using appropriate statistical tests. To examine baseline differences prior to the main analysis, the Mann\u0026ndash;Whitney U test was employed for non-parametric pre-intervention variables. For normally distributed data, a two-way repeated measures ANOVA (2 \u0026times; 2) was conducted to assess group and time interactions. In cases of non-normally distributed data, between-group comparisons were performed using the Mann\u0026ndash;Whitney U test, while within-group comparisons were assessed using the Wilcoxon signed-rank test. Percentage change (Δ%) was calculated to evaluate detailed variations at each time point. Effect sizes (η\u0026sup2;) for the two groups were interpreted based on the thresholds proposed by Fritz et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], with values\u0026thinsp;\u0026lt;\u0026thinsp;0.10 considered small, 0.42 as medium, and 0.80 as large. The statistical significance level was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographic and clinical factors\u0026rsquo; characteristics\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eA total of 60 participants were randomly assigned to either the sham CON (males, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15; females, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15) or the ITSS group (males, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16; females, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14). The mean age of all participants was 22.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80 years, with an average height of 165.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03 cm, body weight of 68.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94 kg, and BMI of 24.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11 kg/m\u0026sup2;. All participants had the average durations of nasal congestion and irregular sleep pattern of 3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 years and 3.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 years. Prior to the experiment, there were no significant differences between the groups in terms of age, sex, height, body composition, smoking status, and alcohol consumption. No significant differences were found between the groups regarding the durations of nasal congestion and irregular sleep duration. The pre-experiment characteristics of the two groups are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Among the controlled variables, prior to the experiment, the dietary intake was 2252.67\u0026thinsp;\u0026plusmn;\u0026thinsp;450.22 kcal for the CON and 2221.00\u0026thinsp;\u0026plusmn;\u0026thinsp;388.29 kcal for the ITSS group, with no significant difference between the two groups (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.477, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.634, \u0026eta;\u0026sup2; = 0.001). After the experiment, the dietary intake measured 2381.23\u0026thinsp;\u0026plusmn;\u0026thinsp;353.09 kcal in the CON and 2350.93\u0026thinsp;\u0026plusmn;\u0026thinsp;367.64 kcal in the ITSS group, again showing no significant difference (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.624, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.533, \u0026eta;\u0026sup2; = 0.002). Similarly, before the experiment, the PA levels were 1814.23\u0026thinsp;\u0026plusmn;\u0026thinsp;147.32 MET\u0026middot;min/ week for the CON and 1917.40\u0026thinsp;\u0026plusmn;\u0026thinsp;235.82 MET\u0026middot;min/week for the ITSS group, with no significant difference (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.648, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.099, \u0026eta;\u0026sup2; = 0.066). After the experiment, the PA levels were recorded as 1730.70\u0026thinsp;\u0026plusmn;\u0026thinsp;243.92 MET\u0026middot;min/week in the CON and 1750.97\u0026thinsp;\u0026plusmn;\u0026thinsp;226.39 MET\u0026middot;min/week in the ITSS group, also showing no significant difference (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.022, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.982, \u0026eta;\u0026sup2; = 0.002).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eInfluence of the ITSS intervention on subjectively felt nasal congestion and sleep state\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAccording to Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, no significant difference was observed between the two groups in the perceived level of nasal congestion prior to the intervention. However, following the intervention, the CON exhibited an increase in perceived nasal congestion, whereas the ITSS group showed a decrease, yielding statistically significant differences between groups, within groups, and in the group-by-time interaction. The perceived sleep condition upon awakening showed no significant difference between the two groups before the intervention. Following the intervention, however, the CON demonstrated an increase in perceived sleep condition, while the ITSS group reported a decrease, leading to significant effects between groups, within groups, and in the interaction effect.\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, changes in perceived nasal congestion and sleep condition following the intervention differed significantly between the groups. In the CON, nasal congestion increased by 11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;22.28%, whereas it decreased by -25.55\u0026thinsp;\u0026plusmn;\u0026thinsp;28.74% in the ITSS group, showing a significant difference between the groups (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA). Similarly, subjective sleep condition increased by 18.88\u0026thinsp;\u0026plusmn;\u0026thinsp;39.59% in the CON but declined by -24.22\u0026thinsp;\u0026plusmn;\u0026thinsp;28.03% in the ITSS group, resulting in a statistically significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eInfluence of the ITSS intervention on respiratory capacity and BP\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs observed in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, there was no significant difference in resting respiratory rate between the two groups prior to the intervention. However, after the intervention, the resting respiratory rate increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. Similarly, no significant differences were observed between the groups in FEV₁ and PEF before the intervention. Following the intervention, however, both FEV₁ and PEF decreased in the CON but increased in the ITSS group, yielding statistically significant interaction effects. As further observed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, there were no significant differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the groups before the intervention. However, after the intervention, SBP and DBP increased in the CON but decreased in the ITSS group, resulting in significant interaction effects.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparative results of respiratory capacity and blood pressure\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eGroups (G)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCON\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eITSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ep\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u0026eta;\u0026sup2;)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime (T)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u0026times;T\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRespiratory capacity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erRR (reps/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.196)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFEV₁ (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.320)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePEF (L/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.059)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.159)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.298)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBlood pressure level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.063)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.283)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.074)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAll data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; rRR, resting respiratory rate; FEV₁, forced expiratory volume in 1 sec; PEF, peak expiratory flow; SBP, systolic blood pressure; DBP, diastolic blood pressure.\u003c/p\u003e\n \u003cp\u003eAs illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the changes in respiratory capacity and BP levels after the intervention revealed significant differences between the groups. The resting respiratory rate increased by 12.39\u0026thinsp;\u0026plusmn;\u0026thinsp;16.70% in the CON, while it decreased by -8.64\u0026thinsp;\u0026plusmn;\u0026thinsp;28.56% in the ITSS group, indicating a significant between-group difference (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA). Regarding pulmonary function, FEV₁ decreased by -6.98\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69% in the CON but increased by 14.29\u0026thinsp;\u0026plusmn;\u0026thinsp;19.54% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB). Similarly, PEF declined by -3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55% in the CON but rose by 23.80\u0026thinsp;\u0026plusmn;\u0026thinsp;27.60% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eC), both showing significant differences between the groups. As for BP, SBP increased by 4.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.10% in the CON, whereas it decreased by -4.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.38% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eD). DBP increased by 2.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66% in the CON and by -3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eE), both also showing significant differences between the groups. These findings suggest that the application of ITSS may have a beneficial effect on cardiopulmonary function.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eInfluence of the ITSS intervention on HRV\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, the HR, a time-domain index of HRV, did not differ significantly between the two groups before the intervention. However, after the intervention, HR increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. SDNN also showed no significant difference between the two groups prior to the intervention. After the intervention, both groups exhibited a decreasing trend, but the CON demonstrated a more pronounced decline compared to the ITSS group, leading to significant differences within groups and in the interaction effect. Meanwhile, RMSSD did not significantly differ between the groups before the intervention. After the intervention, however, RMSSD decreased in the CON and increased in the ITSS group, showing significant differences between groups and in the interaction effect. As further shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, the frequency-domain indices of HRV, namely LF and the LF/HF ratio, did not show significant differences between the two groups before the intervention. However, after the intervention, both LF and the LF/HF ratio increased in the CON but decreased in the ITSS group, resulting in significant between-group and interaction effects. Meanwhile, HF also showed no significant difference between the groups prior to the intervention. After the intervention, however, HF decreased in the CON and increased in the ITSS group, yielding statistically significant differences between groups, within groups, and in the interaction effect.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparative results of HRV\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eGroups (G)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCON\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eITSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ep\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u0026eta;\u0026sup2;)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime (T)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u0026times;T\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTime domain of heart rate variability\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.055)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.203)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSDNN (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.291)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.071)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMSSD (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.103)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.267)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFrequency domain of heart rate variability\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLF (ms\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e657.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e663.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e697.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e592.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.194)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHF (ms\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e711.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e713.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e543.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e163.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e771.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.187)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.489)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLF/HF ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.363)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.372)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.563)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003eAll data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; SDNN, standard deviation of NN intervals; RMSSD, root mean square of successive differences; LF, low frequency; HF, high frequency; ANS, autonomic nervous system.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, HR increased by 3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67% in the CON but decreased by -5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09% in the ITSS group, resulting in a significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eA). Although SDNN decreased by -26.29\u0026thinsp;\u0026plusmn;\u0026thinsp;49.35% in the CON and by -2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;56.74% in the ITSS group, this difference was not statistically significant (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eB). In contrast, RMSSD declined by -13.38\u0026thinsp;\u0026plusmn;\u0026thinsp;24.29% in the CON but increased by 25.75\u0026thinsp;\u0026plusmn;\u0026thinsp;39.49% in the ITSS group, showing a significant difference between the groups (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eC). LF power increased by 7.67\u0026thinsp;\u0026plusmn;\u0026thinsp;19.22% in the CON and decreased by -9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35% in the ITSS group, yielding a significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eD). HF power decreased by -23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;15.30% in the CON but increased by 10.37\u0026thinsp;\u0026plusmn;\u0026thinsp;18.19% in the ITSS group, also showing a significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eE). Lastly, the LF/HF ratio rose by 18.47\u0026thinsp;\u0026plusmn;\u0026thinsp;28.77% in the CON but dropped by -58.17\u0026thinsp;\u0026plusmn;\u0026thinsp;22.02% in the ITSS group, resulting in a statistically significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eF).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eInfluence of the ITSS intervention on EEG factors\u003c/h2\u003e\n \u003cp\u003eAs presented in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, following the intervention, the wide band mean increased in the CON but decreased in the ITSS group, resulting in a significant interaction effect. Although no statistically significant post-intervention differences were observed in delta, theta, beta, or other wave ratios, alpha power decreased in the CON but increased in the ITSS group, showing a significant interaction effect (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Similarly, Gamma power showed a greater increase in the ITSS group compared to the CON after the intervention, indicating a significant interaction effect (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparative results of EEG factors\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eGroups (G)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCON\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eITSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ep\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u0026eta;\u0026sup2;)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaves/Power\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime (T)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u0026times;T\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWide band (\u0026micro;V\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e30.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e25.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.192)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e14.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e13.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.056)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.084)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.025)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTheta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e13.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e15.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.045)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlpha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e10.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e11.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.086)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.094)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.086)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.049)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGamma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.057)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.072)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlpha/Beta ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTheta/Beta ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.018)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003eAll data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs shown in Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, key changes in EEG components after the intervention demonstrated notable group differences. The wide band power increased by 24.90\u0026thinsp;\u0026plusmn;\u0026thinsp;38.15% in the CON but decreased by -13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;33.19% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eA). Alpha power declined by about \u0026minus;\u0026thinsp;3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;32.46% in the CON but increased by 14.90\u0026thinsp;\u0026plusmn;\u0026thinsp;43.56% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eD), and gamma power showed a slight increase of 0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;19.66% in the CON compared to a 13.71\u0026thinsp;\u0026plusmn;\u0026thinsp;32.89% increase in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eF), all of which resulted in significant differences between the groups. Meanwhile, delta (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eB), theta (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eC), and beta powers (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eE), as well as the ABR (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eG) and TBR (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003eH), showed changes within each group after the intervention, but no significant differences were observed between the groups.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eInfluence of the ITSS intervention on sleep factors\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, the sleep quality component of the PSQI-K showed no significant difference between the two groups prior to the intervention. However, after the intervention, sleep quality increased in the CON but decreased in the ITSS group, indicating a significant interaction effect. Similar trends were observed in sleep latency, sleep duration, sleep efficiency, sleep disturbance, and daytime dysfunction, suggesting an overall improvement in sleep quality in the ITSS group. Accordingly, the sum scores of the PSQI-K significantly improved in the ITSS group compared to the CON.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparative results of PSQI-K factors between groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eGroups (G)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCON\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eITSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ep\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u0026eta;\u0026sup2;)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime (T)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG\u0026times;T\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.526)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.098)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.617)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep latency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.129)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.031)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.234)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.081)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.195)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.333)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep disturbance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.176)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.291)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.301)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.239)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSum scores of PSQI-K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.453)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.292)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.608)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003eAll data are presented as mean and standard deviation (SD). CON, control; ITSS, intranasal thermal steam spray; PSQI, Pittsburgh Sleep Quality Index; VAS, visual analogue scale.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAs shown in Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, sleep quality increased by 41.67\u0026thinsp;\u0026plusmn;\u0026thinsp;43.71% in the CON, whereas it decreased by -48.33\u0026thinsp;\u0026plusmn;\u0026thinsp;47.82% in the ITSS group (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eA). Sleep latency also increased by 35.61\u0026thinsp;\u0026plusmn;\u0026thinsp;84.19% in the CON but decreased by -21.78\u0026thinsp;\u0026plusmn;\u0026thinsp;86.0% in the ITSS group, showing a significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eB). Sleep duration (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eC), sleep efficiency (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eD), and sleep disturbance (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eE) increased by 26.11\u0026thinsp;\u0026plusmn;\u0026thinsp;55.48%, 56.11\u0026thinsp;\u0026plusmn;\u0026thinsp;155.52%, and 24.44\u0026thinsp;\u0026plusmn;\u0026thinsp;72.42%, respectively, in the CON, while decreasing by -25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;40.29%, -50.89\u0026thinsp;\u0026plusmn;\u0026thinsp;55.16%, and \u0026minus;\u0026thinsp;44.45\u0026thinsp;\u0026plusmn;\u0026thinsp;34.0% in the ITSS group, all indicating significant differences between the two groups. No notable changes were observed in the use of sleep medication (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eF). However, daytime dysfunction increased by 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;87.68% in the CON and decreased by -32.78\u0026thinsp;\u0026plusmn;\u0026thinsp;41.40% in the ITSS group, revealing a statistically significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eG). Finally, the total PSQI-K score increased by 14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;22.44% in the CON but decreased by -38.90\u0026thinsp;\u0026plusmn;\u0026thinsp;21.99% in the ITSS group, resulting in a significant difference (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003eH).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e This study found that the ITSS technique, which uses moisture rather than medication, improved the nasal environment and provided a more comfortable sensation of nasal breathing by humidifying the nasal cavity. These effects contributed to improvements in both respiratory function and sleep condition. Notably, improved nasal environment was associated with stabilization of the ANS and enhanced relaxation, as evidenced by changes in Wide band, Alpha, and Gamma EEG activity in young adults with nasal congestion and irregular sleep patterns. These neurophysiological responses appear to contribute to the observed improvements in sleep quality.\u003c/p\u003e\u003cp\u003eThe nasal environment, including factors such as nasal cavity volume and resistance, plays a significant role in the transition from wakefulness to sleep. Just as individuals maintain various postures\u0026mdash;such as sitting, reclining, or standing\u0026mdash;while awake, they also adopt different positions during sleep. These postural changes, along with stressors or neurological factors that may occur during the day, can influence nasal cavity volume and, consequently, affect sleep quality. In this context, an epidemiological study by Young et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] identified nasal congestion as a risk factor for sleep-disordered breathing. In a subsequent population-based cohort study with a five-year follow-up [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], chronic nocturnal nasal congestion was found to be a significant risk factor for habitual snoring (odds ratio 4.9). Moreover, individuals with allergy-induced nasal congestion had a 1.8-fold increased risk of developing moderate-to-severe sleep-disordered breathing compared to those without allergic congestion. Beyond epidemiological findings demonstrating the association between nasal congestion and sleep disorders, several laboratory studies have provided experimental evidence for this relationship. Eckert and Younes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] experimentally induced nasal obstruction and demonstrated an increase in both sleep apnea and electroencephalographic arousals during sleep. Similarly, Fitzpatrick et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] showed that modulating nasal resistance using irritants led to the induction of apnea and hypopnea during sleep. Taken together, the existing body of research suggests that nasal congestion\u0026mdash;regardless of its underlying cause\u0026mdash;can be considered a contributing factor to the development of sleep problems. Even within the present study, among the 60 participants, the average duration of nasal congestion was 3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 years, while the duration of sleep irregularity associated with sleep disturbances was 3.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 years. These findings suggest a potential relationship between nasal congestion\u0026mdash;such as that caused by rhinitis\u0026mdash;and sleep-related problems. Considering that the participants were in their early to mid-20s, this association may indicate the potential for more serious consequences later in life. Although not addressed as a primary outcome in this study, the correlation between nasal congestion and irregular sleep patterns was examined, revealing a statistically significant association (r\u0026thinsp;=\u0026thinsp;0.308, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017), suggesting a clear link between nasal congestion and sleep patterns. Additionally, prior to the intervention, the average severity of nasal congestion assessed by VAS among the sixty participants was 4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97, while the perceived severity of sleep-related problems was 4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64. These findings further support the notion that nasal congestion is closely associated with subjective sleep difficulties. Although no model has directly explained or demonstrated that changes in nasal resistance can induce sleep problems, considering the Starling resistor model in relation to nasal resistance provides a possible explanation. If a narrowed region within the nasal cavity or any other cause leads to increased nasal resistance, negative pressure may develop downstream of the affected area. This negative pressure could contribute to the collapse of the oropharyngeal region, which lacks skeletal support [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Furthermore, during sleep, the muscles comprising the oropharyngeal region are in a more relaxed state compared to wakefulness, making them more susceptible to collapse due to negative pressure [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo date, numerous studies have reported that treating nasal congestion can improve the quality of life in patients with sleep problems. Li et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] reported an improvement in patients' quality of life following nasal surgery. Similarly, Miyazaki et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] conducted a study on 54 obstructive sleep apnea patients using a catheter-based pressure transducer to examine the relationship between nasal congestion and obstructive sleep apnea. Their findings suggested that while nasal congestion itself may not be a primary cause of obstructive sleep apnea, it can act as a contributing factor. Additionally, L\u0026ouml;th et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] demonstrated that the use of a nostril dilator increased nasal breathing in snoring patients, leading to improved quality of life. Recently, the ITSS device, developed to alleviate nasal congestion, has been reported to help relieve congestion by delivering warm water to the nasal cavity using jet stream wet technology [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the underlying mechanisms through which ITSS influences sleep quality remain largely unexplored. Specifically, how ITSS improves respiratory function by enhancing nasal hydration and the perception of nasal openness\u0026mdash;and how these changes subsequently affect the ANS, brain activity, and ultimately sleep patterns\u0026mdash;has not yet been fully investigated. To address this, the present study investigated the effects of ITSS treatment over an eight-week period. The results showed that nasal congestion severity, as assessed by the VAS, increased by approximately 12% in the CON, whereas the ITSS group experienced a 26% reduction following ITSS treatment (Z = \u0026minus;\u0026thinsp;4.576, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, sleep condition worsened by around 19% in the CON but improved by about 24% in the ITSS group (Z = \u0026minus;\u0026thinsp;3.899, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These improvements were also reflected in respiratory function: the resting respiratory rate increased by approximately 12% in the CON, whereas it decreased by nearly 9% in the ITSS group (Z = \u0026minus;\u0026thinsp;3.506, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, while FEV₁ and PEF showed minimal change or slight decreases in the CON, the ITSS group demonstrated significant increases of about 14% (Z = \u0026minus;\u0026thinsp;4.274, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 24% (Z = \u0026minus;\u0026thinsp;3.963, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively, suggesting that the improvement in nasal congestion contributed to enhanced respiratory function. This improvement in respiratory function appeared to contribute to reductions in BP, as evidenced by ANS markers in the ITSS group. Specifically, a decrease in SDNN and an increase in RMSSD were observed, indicating a shift toward parasympathetic nervous dominance. Moreover, HF power, which reflects parasympathetic nervous activity, decreased by approximately 23% in the CON but increased by around 10% in the ITSS group. In contrast, the LF/HF ratio, representing sympathetic nervous activity, increased by about 18% in the CON but decreased by nearly 58% in the ITSS group. These results suggest that the ITSS intervention may have facilitated ANS stabilization and contributed to improved BP regulation.\u003c/p\u003e\u003cp\u003eTo date, no research has directly examined the effects of intranasal steam spray on nasal congestion relief and brain wave changes during sleep or daytime activities such as working. However, a substantial body of literature has investigated the relationship between nasal congestion, sleep quality, and brain wave activity. Understanding these connections is crucial, as nasal congestion can significantly impact sleep architecture, cognitive function, and overall well-being. Several studies have explored the effects of improving nasal environment on brain wave characteristics and sleep patterns. Walsh et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] reported that nasal expansion led to an increase in delta wave activity, which is closely associated with deep sleep and physical recovery. Delta waves (0.5\u0026ndash;4 Hz) play a fundamental role in restorative sleep, facilitating tissue repair, immune function, and overall physiological recovery [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The enhancement of delta wave activity suggests that nasal expansion could contribute to improved sleep quality and physical restoration. According to the EEG analysis in this study, the delta wave increased by nearly 3.23% in the ITSS group, whereas it significantly decreased by approximately 11% in the sham CON (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025). This trend appears to be consistent with previous studies; however, no significant interaction effect was observed. Therefore, further in-depth investigations are warranted to elucidate the specific mechanisms underlying these changes. This suggests that intranasal steam spray may help regulate sleep-related brain activity by increasing body temperature and alleviating nasal congestion to some extent. This trend is further supported by the findings in the ITSS group, where alpha wave, related to relaxation and a calm mental state, improved by around 15% after the ITSS intervention (interaction effect \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Moreover, gamma wave, which is closely linked to stress, anxiety, and cognitive processing, increased by around 14% (interaction effect \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038). Meanwhile, wide band mean power typically ranges between 20\u0026ndash;40 \u0026micro;V\u0026sup2; in a normal resting state. In this study, the CON showed a 25% increase from 29.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08 \u0026micro;V\u0026sup2; at baseline to 33.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76 \u0026micro;V\u0026sup2; post-intervention, indicating a shift toward a heightened arousal state. In contrast, the ITSS group exhibited a 13% decrease from 30.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.29 \u0026micro;V\u0026sup2; to 25.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.72 \u0026micro;V\u0026sup2;, suggesting a transition toward a more relaxed physiological state. These results suggest that ITSS may help reduce psychological stress and alleviate mental tension by moistening and expanding the nasal passages. In relation to this, several previous studies have indicated that theta wave plays a crucial role in the transition between wakefulness and sleep, supporting memory processing and emotional regulation [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In other words, an increase in theta wave activity suggests that nasal expansion may facilitate smoother sleep transitions and enhance cognitive processing during sleep. Additionally, alpha wave, which is associated with relaxation, meditation, and the transition to sleep, has been shown to increase after nasal expansion. Since alpha wave activity is often linked to a state of wakeful rest and is considered essential for initiating sleep [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], the observed increase in alpha wave in this study indicates that nasal expansion promotes psychological relaxation and prepares the brain for sleep onset. Furthermore, the findings align with the study by Hammer et al. [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], which reported that gamma wave\u0026mdash;frequently activated during REM sleep and associated with high-order cognitive functions such as emotional regulation and problem-solving\u0026mdash;increased with nasal expansion. In this study, beta wave activity showed a notable increase in the CON, whereas a relatively smaller increase was observed in the ITSS group. This pattern may suggest that the ITSS group experienced a more stable and calmer psychological state. Supporting this, Pei et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] reported that reduced beta wave, resulting from nasal expansion, contributes to a more relaxed physiological state, potentially mitigating hyperarousal that can hinder sleep onset and maintenance. Similarly, some of research noted that beta activity plays a critical role in motor and sensory regulation, as well as in stabilizing and maintaining sleep by ensuring efficient neural communication during sleep [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Ultimately, improved nasal condition induced by ITSS may positively influence beta wave, which is associated with physical stability and improved concentration. However, as both groups in the present study showed increased beta waves with no statistically significant interaction effect, further research is warranted to better understand the underlying mechanisms.\u003c/p\u003e\u003cp\u003eTo our knowledge, no studies have directly examined the effects of ITSS on nasal congestion relief and PSQI. However, it is well known that nasal congestion negatively affects sleep quality, and various nasal sprays have been reported to help alleviate this issue. In other words, nasal congestion can cause breathing difficulties during sleep, leading to a decline in sleep condition and quality, which may be reflected in an increased PSQI score. For example, saline sprays are commonly used to rinse the nasal passages, remove allergens, and alleviate dryness inside the nasal cavity [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Hermelingmeier et al. [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] highlighted that intranasal saline therapy is a safe, cost-effective, and efficient treatment, as it helps remove mucus, accumulated secretions, and inflammatory cytokines from the nasal passages. Similarly, Fokkens et al. [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] reported that it supports mucociliary clearance and reduces mucosal swelling. As a result, intranasal saline therapy is widely recommended as an adjunct treatment for sinonasal conditions such as rhinosinusitis, rhinitis, and upper respiratory tract infections. The intranasal steam spray used in this study introduces 43\u0026deg;C water into the nasal cavity, promoting nasal expansion and increasing cranial temperature, which may help induce sleep. Notably, the results of this study showed that the \u0026ldquo;sleep quality\u0026rdquo; score on the PSQI-K improved by approximately 48% following ITSS intervention, whereas the sham CON exhibited a deterioration of about 42%. Moreover, in terms of sleep latency\u0026mdash;the time taken to fall asleep\u0026mdash;the CON showed an increase of approximately 36% after the intervention, whereas the ITSS group exhibited a decreasing trend of about 22%, approaching the critical threshold of falling asleep within 30 min. In addition, regarding the PSQI-K subscales\u0026mdash;\u0026ldquo;sleep duration,\u0026rdquo; \u0026ldquo;sleep efficiency\u0026rdquo; (the ratio of actual sleep time to time spent in bed), \u0026ldquo;sleep disturbances,\u0026rdquo; and \u0026ldquo;daytime dysfunction\u0026rdquo; (reflecting the impact of sleepiness and fatigue on daily activities)\u0026mdash;the placebo-controlled group showed an increasing trend after the intervention, whereas the ITSS group exhibited significant reductions, indicating an interaction effect. Consequently, the total PSQI-K score related to sleep quality increased by approximately 15% in the CON but decreased by 39% in the ITSS group, approaching the threshold score of 7. Considering the PSQI-K criteria established by Sohn et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], where a score of 8.5 or lower indicates good sleep quality and a score above 8.5 indicates poor sleep quality, these findings strongly suggest that intranasal thermal steam spray has a highly positive impact on sleep quality. Meanwhile, a study using the NOZOVENT nasal dilator in 15 individuals with non-pathological nasal structures reported no significant changes in apnea\u0026ndash;hypopnea events or oxygen saturation, with only a limited reduction in snoring episodes during slow-wave sleep [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Consistently, a systematic review found that most studies reported no improvement in AHI with external nasal dilators, while minor improvements were observed only with certain internal dilators [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Taken together, these findings highlight that the effects of nasal dilators on objective sleep parameters remain limited, and further research is warranted to clarify their clinical significance. In addition, although this study conducted a scientifically calculated sample size estimation and recruited participants accordingly as part of a clinical trial to evaluate the intervention's effectiveness, the overall sample size may still be considered relatively small. Since this study aimed to investigate the impact of ITSS treatment on changes in physiological and psychological variables related to nasal environment improvement, further detailed and long-term studies are recommended. Additionally, as the study participants were adults in their 20s experiencing nasal congestion and sleep disturbances, further research involving a more diverse population, including various patient groups, is encouraged.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study concluded that the application of ITSS enhanced the nasal environment\u0026mdash;particularly by alleviating the sensation of nasal congestion\u0026mdash;which in turn led to favourable changes in cardiopulmonary function. These physiological improvements may further contribute to better sleep quality by promoting ANS balance and stabilizing brain activity.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancial support\u003c/strong\u003e:\u0026nbsp;This work was not supported by external organ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe study was retrospectively registered on April 3, 2025, in the Clinical Research Information Service (https://cris.nih.go.kr/cris/search/listDetail.do/) under registration number KCT0010381.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the patients who permitted us to use their data for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJaehoon Kim: conceptualization, methodology, project administration, writing \u0026ndash; review and editing, resources. Jaehoon Hwang: conceptualization, funding acquisition, methodology, validation, resources. Kyungryul Chung: conceptualization, validation, writing \u0026ndash; review and editing, resources. Youngsoo Jin: methodology, validation, writing \u0026ndash; review and editing, resources. Yong-Seok Jee: conceptualization, data curation, formal analysis, writing \u0026ndash; original draft, writing \u0026ndash; review and editing, validation, methodology, resources. All the authors provided critical feedback and helped shape the research, analysis, and manuscript. All the authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was not supported by external organ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers followed the principles outlined in the Declaration of Helsinki. This study adhered to ethical guidelines, with all participants providing informed consent after being fully informed of the study\u0026rsquo;s purpose and procedures. Confidentiality was maintained, and participants could withdraw at any time. They were also offered access to the study\u0026rsquo;s results if requested. The Ethics Committee of Hanseo University (HS24-12-18) approved this study, and the study\u0026nbsp;was retrospectively registered on April 3, 2025, in the Clinical Research Information Service under registration number KCT0010381.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interest in reporting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eKorea Sleep Industry Association, Korea; \u003csup\u003e2\u003c/sup\u003e Department of Public Health ∙ Special Education, Graduate School of Health Promotion, Hanseo University, Korea\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBłaszczyk JW. 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Arch Otolaryngol Head Neck Surg. 2008;134(4):429\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiyazaki S, Itasaka Y, Ishikawa K, Togawa K. Influence of nasal obstruction on obstructive sleep apnea. Acta Otolaryngol Suppl. 1998;537:43\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL\u0026ouml;th S, Petruson B, Wir\u0026eacute;n L, Wilhelmsen L. Better quality of life when nasal breathing of snoring men is improved at night. Arch Otolaryngol Head Neck Surg. 1999;125(1):64\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalsh JK, Hall-Porter JM, Griffin KS, Dodson ER, Forst EH, Curry DT, Eisenstein RD, Schweitzer PK. Enhancing slow wave sleep with sodium oxybate reduces the behavioral and physiological impact of sleep loss. Sleep. 2010;33(9):1217\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDesai D, Momin A, Hirpara P, Jha H, Thaker R, Patel J. 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Pulm Med. 2016;2016:4841310.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Intranasal steam, Nasal congestion, Sleep quality, Autonomic nervous system, EEG, Heart rate variability, PSQI, Respiratory function","lastPublishedDoi":"10.21203/rs.3.rs-7253632/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7253632/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Intranasal thermal steam spray (ITSS) has been suggested to relieve nasal stuffiness and improve sleep-related symptoms. However, its effects on respiratory capacity, neurological functions, including autonomic nervous system (ANS) and brain activities, remain underexplored. Therefore, this study aimed to investigate the effects of an ITSS intervention on nasal condition, respiratory and neurological functions, and sleep quality in young adults with nasal congestion and irregular sleep patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Sixty university students (aged 20–26 years) with an average duration of nasal congestion and sleep irregularity of over three years participated. Two dormitories were randomly assigned to either a control group (CON; \u003cem\u003en \u003c/em\u003e= 30) or an intervention group (ITSS; \u003cem\u003en\u003c/em\u003e = 30). The ITSS device, delivering 43°C thermal wet steam using jet stream technology, was administered for 15 min, 3 times per week, 30 min before bedtime for 8 weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e After the intervention, subjective nasal congestion and sleep conditions deteriorated in the CON but improved in the ITSS (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001). Pulmonary outcomes, including reduced respiratory rate (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001) and increased FEV₁ (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and PEF (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), improved only in the ITSS. Heart rate variability and blood pressure indices also showed favourable changes. EEG analysis revealed increased wide band, alpha, and gamma powers in the ITSS, contrasting with declines in the CON (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). In the ITSS group, PSQI-K components improved, with daytime dysfunction reduced by 32.78 ± 41.40% (\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.001). Total PSQI-K scores rose in the CON group (+14.64 ± 22.44%) but declined in the ITSS group (−38.90 ± 21.99%), showing a significant difference (\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e These findings suggest that ITSS enhances airflow by humidifying the nasal environment, thereby facilitating respiratory function and stabilizing ANS activity and brain function. This process ultimately contributes to improved overall sleep quality in young adults experiencing nasal congestion and irregular sleep patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was retrospectively registered on April 3, 2025, in the Clinical Research Information Service (https://cris.nih.go.kr/cris/search/listDetail.do/) under registration number KCT0010381.\u003c/p\u003e","manuscriptTitle":"A randomized controlled trial investigating the effect of thermal steam spray on nasal condition, neurological function, and sleep quality in young adults with nasal congestion and irregular sleep patterns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 13:38:52","doi":"10.21203/rs.3.rs-7253632/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-16T16:26:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166984828295156378216782944710001919535","date":"2026-04-29T14:58:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131694025130454284057753353916109418092","date":"2025-09-14T11:43:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T16:58:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T07:46:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-14T09:41:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T08:11:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-08-14T08:06:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7fd55b9-b943-4eab-b9c3-e9bcf770428b","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-16T16:26:58+00:00","index":97,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T13:38:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 13:38:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7253632","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7253632","identity":"rs-7253632","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}