1021 Effect of Dietary Nitrate Supplementation on Sleep in Chronic Obstructive Pulmonary Disease Patients

Abstract Introduction Chronic obstructive pulmonary disease (COPD) requires the use of accessory muscles to overcome inadequate ventilation. The activity of these voluntary muscles is compromised during sleep, resulting in insufficient ventilation, oxygen desaturation and disruption of sleep. Nitrate supplementation with dietary beetroot juice (DBJ) is known to increase the efficiency of oxygen utilization in non-COPD individuals; its therapeutic effect in COPD is uncertain. Methods In a repeated measured experiment involving 15 COPD patients, subjects consumed either 70 mL of beetroot juice containing nitrate (~6.2 mmol NO3-) or placebo (NO3--depleted juice) immediately before bedtime. Sleep states were defined based on F4-O2 electroencephalogram and masseter electromyogram. All subjects spent at least 6.2 hrs in bed; the data analysis was therefore restricted to the first 6 hrs in bed. Results Standard polysomnography indicated no changes in the amount of time spent in any sleep stages. Wake-to-N2 transitions were greater than two-fold more frequent after placebo (a total of 21 observed) than DBJ (9 observed), resulting in a significant main effect of treatment (F1,14=7.3, P=0.017). N2-to-wake transitions were nearly 3-fold more frequent after placebo (a total of 35 observed) than DBJ (12 observed), resulting in a significant main effect of treatment (F1,14=2.52, P=0.024). Direct wake-to-REMS transitions were observed four times after placebo and never after DBJ (F1,14=2.26, P=0.041). DBJ also resulted in sustained elevation of peripheral oxygen saturation (SpO2), measured by pulse oximetry, during episodes of wake after sleep onset (WASO). Two minutes into WASO after DBJ SpO2 was elevated by 1.09 + 0.31% relative to pre-WASO; two minutes into WASO after placebo SpO2 was elevated by 0.08 + 0.54% relative to pre-WASO (P=0.012). Conclusion Collectively, the reduced frequency of atypical transitions after DBJ are indicative of an improvement of sleep quality. DBJ is thus a potential adjunct therapy for disordered sleep in COPD. Support N/A