Attali Valérie, Jacq Olivier, Martin Karine, Arnulf Isabelle, Similowski Thomas
UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005 Paris, France.
AP-HP, Département R3S, Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France.
J Clin Med. 2021 Dec 24;11(1):99. doi: 10.3390/jcm11010099.
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer's test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI ( = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, = 0.0001) and 24 h (23 [10; 30] L/min, = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.
(1) 背景：蝶腭神经节（SPG）的整骨手法可阻断节后感觉纤维的作用。这种神经调节可减轻鼻塞并增强上呼吸道稳定性。我们对31例阻塞性睡眠呼吸暂停综合征（OSAS）患者进行了SPG手法治疗的研究；(2) 方法：随机、对照、双盲、交叉研究。参与者先接受主动手法治疗（AM），然后接受假手法治疗（SM），或反之。主要终点是呼吸暂停低通气指数（AHI）。次要终点是在30分钟和24小时时，通过鼻吸气峰流量（PNIF）评估的鼻塞变化以及通过清醒临界关闭压[清醒Pcrit]）评估的上呼吸道稳定性。手法治疗后立即评估泪液分泌试验和疼痛情况。记录触觉/味觉/嗅觉/听觉/伤害性/视觉感觉。全程收集不良事件。(3) 结果：SPG手法治疗未降低AHI（P = 0.670）。在30分钟（AM - SM：18 [10；38] L/分钟，P = 0.0001）和24小时（23 [10；30] L/分钟，P = 0.001）时，PNIF在AM后升高，但在SM后未升高。在30分钟或24小时时，清醒Pcrit（AM - SM）无显著差异。与SM后（37%）相比，AM后报告感觉的患者更常见（100%）。报告的不良事件很少，未报告严重不良事件。(4) 结论：不支持将SPG手法治疗作为OSAS的治疗方法，但可减轻鼻塞。在将这种方法用于减少持续气道正压通气（CPAP）治疗患者或轻度OSAS患者的鼻充血之前，这种效果仍有待在更大样本中得到证实。
