Mysterious syndrome warrants further research

Strategies to improve glucose control and detect nocturnal hypoglycaemia are needed to prevent ‘dead in bed syndrome’ in young people with type 1 diabetes, Sydney researchers conclude. The unpredictable syndrome, seen in a subgroup of young patients with type 1 diabetes, affects people in good health who unexpectedly die in their sleep. While its underlying cause is unknown, evidence suggests that cardiac autonomic dysfunction and hypoglycaemia are predisposing factors and that genetic factors may also be linked to the syndrome, the researchers wrote in their report. “[These factors] may lead to alterations in cardiac repolarisation and QT interval prolongation which may ultimately trigger ventricular arrhythmias leading to sudden death,” they said. However, they added that nocturnal hypoglycaemia rarely results in sudden death, which implies “other mechanisms are likely to be involved in the pathogenesis of sudden unexplained deaths in type 1 individuals”. They noted it is unknown whether the combination of factors acts alone or collectively, and added that the condition requires further investigation to identify those at risk and prevent fatalities. They suggested that new technology and drug therapies such as beta-blockers and the implantation of defibrillator devices will help to improve glucose control and detect nocturnal hypoglycaemia. “Elucidating and understanding the underlying mechanisms and triggers will help unlock the mysteries of the dead in bed syndrome and initiate preventative strategies,” they concluded. International Journal of Cardiology 2009; 138:91-93. http://www.sciencedirect.com/science/journal/01675273...