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Upper airway stabilization by osteopathic manipulation of the sphenopalatine ganglion versus sham manipulation in OSAS patients: a proof-of-concept, randomized, crossover, double-blind, controlled study.

Abstract Osteopathic manipulative treatment (OMT) of the sphenopalatine ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and is thought to increase pharyngeal stability. This trial was designed to study the effects of this treatment on pharyngeal stability evaluated by critical closing pressure in obstructive sleep apnoea syndrome.
PMID
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Authors

Mayor MeshTerms
Keywords

Critical closing pressure

Intraoral manipulation

Obstructive sleep apnoea

Osteopathic manipulative treatment

Sphenopalatine ganglion

Journal Title bmc complementary and alternative medicine
Publication Year Start




PMID- 29262824
OWN - NLM
STAT- MEDLINE
DCOM- 20180103
LR  - 20180103
IS  - 1472-6882 (Electronic)
IS  - 1472-6882 (Linking)
VI  - 17
IP  - 1
DP  - 2017 Dec 20
TI  - Upper airway stabilization by osteopathic manipulation of the sphenopalatine
      ganglion versus sham manipulation in OSAS patients: a proof-of-concept,
      randomized, crossover, double-blind, controlled study.
PG  - 546
LID - 10.1186/s12906-017-2053-0 [doi]
AB  - BACKGROUND: Osteopathic manipulative treatment (OMT) of the sphenopalatine
      ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and 
      is thought to increase pharyngeal stability. This trial was designed to study the
      effects of this treatment on pharyngeal stability evaluated by critical closing
      pressure in obstructive sleep apnoea syndrome. METHODS: This single-centre,
      randomized, crossover, double-blind study compared active manipulation and sham
      manipulation of the SPG. Randomization was computer-generated. Patients each
      received one active manipulation and one sham manipulation at an interval of 21
      days and were evaluated 30 min and 48 h after each session administered by a
      qualified osteopath. Neither the patients, nor the investigator performing the
      evaluations were informed about the order of the two techniques (double-blind).
      The primary endpoint was the percentage of responding patients presenting
      increased pharyngeal stability defined by a variation of critical closing
      pressure (Pcrit) of at least -4 cmH2O at 30 min. Secondary endpoints were the
      variation of Pcrit in absolute values, sleepiness and snoring. Others endpoints
      were lacrimation (Schirmer's test), induced pain, sensations experienced during
      OMT. RESULTS: Ten patients were included and nine (57 [50; 58] years, comprising 
      7 men, with an apnoea-hypopnoea index of 31.0 [25.5; 33.2]/h; (values are median 
      [quartiles])) were analysed. Seven patients were analysed for the primary
      endpoint and nine patients were analysed for secondary endpoints. Five patients
      responded after active manipulation versus no patients after sham manipulation (p
      = 0.0209). Active manipulation induced more intense pain (p = 0.0089), increased 
      lacrimation (ns) and more tactile, nociceptive and gustatory sensations (13
      versus 1) compared to sham manipulation. No significant difference was observed
      for the other endpoints. CONCLUSIONS: Osteopathic manipulative treatment of the
      SPG may improve pharyngeal stability in obstructive sleep apnoea syndrome. This
      trial validates the feasibility of the randomized, controlled, double-blind
      methodology for evaluation of this osteopathic treatment. Studies on a larger
      sample size must specify the efficacy on the apnoea-hypopnoea index. TRIAL
      REGISTRATION: The study was retrospectively registered in the clinicaltrial.gov
      registry under reference NCT01193738 on 1st September 2010 (first inclusion May
      19, 2010).
FAU - Jacq, Olivier
AU  - Jacq O
AD  - Sorbonne Universites, UPMC Universite Paris 06, INSERM, UMRS1158 Neurophysiologie
      Respiratoire Experimentale et Clinique, Paris, France.
FAU - Arnulf, Isabelle
AU  - Arnulf I
AD  - AP-HP, Groupe Hospitalier Pitie-Salpetriere Charles Foix, Service d'Exploration
      des Pathologies du Sommeil (Departement "R3S"), 47-83 boulevard de l'hopital,
      75013, Paris, France.
FAU - Similowski, Thomas
AU  - Similowski T
AD  - Sorbonne Universites, UPMC Universite Paris 06, INSERM, UMRS1158 Neurophysiologie
      Respiratoire Experimentale et Clinique, Paris, France.
AD  - AP-HP, Groupe Hospitalier Pitie-Salpetriere Charles Foix, Service d'Exploration
      des Pathologies du Sommeil (Departement "R3S"), 47-83 boulevard de l'hopital,
      75013, Paris, France.
FAU - Attali, Valerie
AU  - Attali V
AUID- ORCID: http://orcid.org/0000-0001-5444-9223
AD  - Sorbonne Universites, UPMC Universite Paris 06, INSERM, UMRS1158 Neurophysiologie
      Respiratoire Experimentale et Clinique, Paris, France. [email protected]
AD  - AP-HP, Groupe Hospitalier Pitie-Salpetriere Charles Foix, Service d'Exploration
      des Pathologies du Sommeil (Departement "R3S"), 47-83 boulevard de l'hopital,
      75013, Paris, France. [email protected]
AD  - Department of Sleep Medicine ("Service des Pathologies du Sommeil"),
      Pitie-Salpetriere Hospital, 47-83 Bd de l'Hopital, 75651, Paris Cedex 13, France.
      [email protected]
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20171220
PL  - England
TA  - BMC Complement Altern Med
JT  - BMC complementary and alternative medicine
JID - 101088661
SB  - IM
MH  - Cross-Over Studies
MH  - Double-Blind Method
MH  - Female
MH  - Ganglia, Parasympathetic/*physiology
MH  - Humans
MH  - Male
MH  - Manipulation, Osteopathic/adverse effects/*methods/statistics & numerical data
MH  - Middle Aged
MH  - Pterygopalatine Fossa/*innervation
MH  - Sleep Apnea, Obstructive/physiopathology/*therapy
PMC - PMC5738827
OTO - NOTNLM
OT  - Critical closing pressure
OT  - Intraoral manipulation
OT  - Obstructive sleep apnoea
OT  - Osteopathic manipulative treatment
OT  - Sphenopalatine ganglion
EDAT- 2017/12/22 06:00
MHDA- 2018/01/04 06:00
CRDT- 2017/12/22 06:00
PHST- 2017/05/17 00:00 [received]
PHST- 2017/12/07 00:00 [accepted]
PHST- 2017/12/22 06:00 [entrez]
PHST- 2017/12/22 06:00 [pubmed]
PHST- 2018/01/04 06:00 [medline]
AID - 10.1186/s12906-017-2053-0 [doi]
AID - 10.1186/s12906-017-2053-0 [pii]
PST - epublish
SO  - BMC Complement Altern Med. 2017 Dec 20;17(1):546. doi: 10.1186/s12906-017-2053-0.