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The Somatic Connection  |   May 2018
Osteopathic Manipulation Shown to Improve Upper Airway Stabilization
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   May 2018
Osteopathic Manipulation Shown to Improve Upper Airway Stabilization
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 348a-349. doi:https://doi.org/10.7556/jaoa.2018.070
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 348a-349. doi:https://doi.org/10.7556/jaoa.2018.070
Jacq O, Arnulf I, Similowski T, Attali V. 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. BMC Complement Altern Med. 2017;17(1):546. doi:10.1186/s12906-017-2053-0 
Researchers in the Department of Sleep Medicine at the Pitié-Salpêtrière Hospital in Paris, France, evaluated the effect of osteopathic manipulation on upper airway stabilization in patients with obstructive sleep apnea syndrome (OSAS). In this proof-of-concept crossover study, 9 patients (7 men, 2 women) were randomly assigned to active manipulation (AM) or sham manipulation (SM). Some patients received the AM at visit 1 and PM at visit 3, and others received PM at visit 1 and AM at visit 3. Each patient was his or her own control. 
Inclusion criteria were age at least 18 years with OSAS and an apnea-hypopnea index of at least 15/h and no more than 45/h. Patients were excluded if they were treated by nocturnal continuous positive airway pressure or mandibular advancement devices and were unable to temporarily stop this treatment for the purposes of the study. Patients who had complete nasal obstruction, were treated with serotonin reuptake inhibitors, or had a body mass index greater than 40 were also excluded. 
The description of the AM was consistent with a commonly used intraoral osteopathic cranial manipulative medicine procedure called the sphenopalatine ganglion release. The SM consisted of hand placement in the same respective positions as for the AM, but the fifth digit was not advanced to the pterygoid process and the finger pressure was lateral toward the oral mucosa. Both the patient and the investigator analyzing the data were blinded to the intervention (AM or SM), and the osteopath who applied all of the interventions was not involved in data analysis. 
The primary outcome measure was the percentage of responding patients presenting pharyngeal stability defined by an improvement of critical closing pressure (Pcrit) of at least −4 cm H2O at 30 minutes after the intervention. Pcrit was measured at baseline, 30 minutes, and 48 hours after the intervention. 
Nine patients were included in the study, but only 7 completed the primary outcome measures. At 30 minutes, the percentage of AM responders (5 of 7) was significantly higher than SM responders (0 of 7) (P=.0209). Four of the AM responders at 30 minutes were still responders at 48 hours. Other findings were that AM produced more intense pain (P=.0089) and increased lacrimation. This novel study suggests positive clinical applications of osteopathic cranial manipulative medicine if subsequent research confirms these findings.