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Osteopathic Manipulation Shown to Improve Upper Airway Stabilization

Published/Copyright: May 1, 2018
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 118 Issue 5

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.

University of California, San Diego School of Medicine
Published Online: 2018-05-01
Published in Print: 2018-05-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
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  23. THE SOMATIC CONNECTION
  24. Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
  25. Cervical HVLA Used as Single Intervention Improves Motion and Strength
  26. Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function
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https://doi.org/10.7556/jaoa.2018.070
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Psychogenic Dizziness: An Important but Overlooked Differential Diagnosis in the Workup of the Dizzy Patient
  3. THE SOMATIC CONNECTION
  4. Osteopathic Manipulation Shown to Improve Upper Airway Stabilization
  5. HEALTH POLICY
  6. Implications of a National Health Insurance Marketplace
  7. IN MY VIEW
  8. Toward a Renewal of Patient Care: Insights From Viktor Frankl, MD, PhD
  9. AOA COMMUNICATION
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist
  14. REVIEW
  15. Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Faculty Vitality in Osteopathic Medical Schools: A Pilot Study
  18. SPECIAL COMMUNICATION
  19. Women in Osteopathic and Allopathic Medical Schools: An Analysis of Applicants, Matriculants, Enrollment, and Chief Academic Officers
  20. CASE REPORT
  21. Atrial Flutter With Exercise-Induced 1:1 Atrioventricular Conduction
  22. Restoration of Full Shoulder Range of Motion After Application of the Fascial Distortion Model
  23. THE SOMATIC CONNECTION
  24. Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
  25. Cervical HVLA Used as Single Intervention Improves Motion and Strength
  26. Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function
  27. Fibromyalgia Symptoms Reduced by Osteopathic Manipulative Medicine and Gabapentin
  28. Myofascial Release Therapy Beneficial for Patients With Chronic Low Back Pain
  29. CLINICAL IMAGES
  30. Posterior Leukoencephalopathy Syndrome
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