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

Download Full-text

Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00095 ◽

2020 ◽

Vol 29 (2) ◽

pp. 864-872

Author(s):

Fernanda Borowsky da Rosa ◽

Adriane Schmidt Pasqualoto ◽

Catriona M. Steele ◽

Renata Mancopes

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Oral Cavity ◽

Pulmonary Disease ◽

Thermal Sensation ◽

Sensory Function ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Age Related ◽

Copd Patients

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

Download Full-text