The Effect of Dietary Nitrate on Nocturnal Sleep-Disordered Breathing and Arterial Oxygen Desaturation at High Altitude

Patrician, Alexander, Harald Engan, David Lundsten, Ludger Grote, Helena Vigetun-Haughey, and Erika Schagatay. The effect of dietary nitrate on nocturnal sleep-disordered breathing and arterial oxygen desaturation at high altitude. High Alt Med Biol 19:21–27, 2018.—Sleep-disordered breathing and fluctuations in arterial oxygen saturation (SaO 2 ) are common during sleep among lowlanders ascending to high altitude. Dietary nitrate (NO 3 − ) supplementation has been shown to lower the O 2 consumption in various conditions. Our objective was to investigate whether dietary NO 3 − could reduce sleep-disordered breathing and SaO 2 desaturation during sleep at altitude. Cardiorespiratory responses during sleep were measured in 10 healthy lowlanders at 330 m and then again in the Himalayas at 3700–4900 m. Each subject received two 70 mL shots of either beetroot juice (BR; ∼5.0 mmol NO 3 − per shot) or placebo (PL: ∼0.003 mmol NO 3 − per shot) in a single-blinded, weighted order over two consecutive nights at altitude. At 2.5–4.5 hours into sleep at altitude, BR increased the SaO 2 desaturation drop (4.2 [0.1]% with PL vs. 5.3 [0.4]% with BR; p = 0.024) and decreased the SaO 2 desaturation duration (14.1 [0.9] seconds with PL to 11.1 [0.9] seconds with BR; p = 0.0.041). There was a reduction in breaths with flow limitation ( p = 0.025), but no changes in Apnea-Hypopnea Index (AHI), mean and minimum SaO 2 . The study suggests BR supplementation does not improve AHI or oxygenation, but may increase fluctuations in arterial O 2 saturation during sleep at altitude in native lowlanders.