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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Dead-in-bed syndrome

Introduction

Dead-in-bed syndrome unexpected death in young type 1 diabetic patients “with no history of diabetic complications, and in particular no autonomic dysfunction. They are found in an undisturbed bed, which seems to exclude death during a convulsive attack”[1].

This was first described in a series of 20 patients in 1991[2].

Etiology

Etiology

Proposed causes include:

  • Hypoglycemic unawareness[3][4] or the ‘hypoglycemia-unawareness syndrome’[5]
  • Hypoglycemia-induced ventricular dysrhythmia due to QT prolongation during hypoglycemia[6][7]
  • Hypoglycemia-induced autonomic dysfunction which may lead to ventricular dysrhythmia due to QT prolongation[8]
Diagnosis

Diagnosis

Diabetic ketoacidosis may be sought during autopsy by vitreous fluid biochemical analyses [9].

Prevention

Prevention

Nocturnal hypoglycemia may be prevented by glucose sensors

Clinical practice guidelines by the American Diabetic Association recommendClosing </ref> missing for <ref> tag.

The MiniMed(®) Paradigm™ Veo system may be the most effective system[10]. However, the cost effectiveness is not certain[11].

Closed loop systems (artificial pancreases) may be effective according to a systematic review[12].

Sensors may not completely prevent dead in bed syndrome[13]

References

References

  1. ↑ Sovik O, Thordarson H (1999). “Dead-in-bed syndrome in young diabetic patients”. Diabetes Care. 22 Suppl 2: B40–2. PMID 10097898.
  2. ↑ Tattersall RB, Gill GV (1991). “Unexplained deaths of type 1 diabetic patients”. Diabet Med. 8 (1): 49–58. PMID 1826245.
  3. ↑ Hanas R (1997). “Dead-in-bed syndrome in diabetes mellitus and hypoglycaemic unawareness”. Lancet. 350 (9076): 492–3. doi:10.1016/S0140-6736(05)63081-4. PMID 9274591.
  4. ↑ Gerich JE, Mokan M, Veneman T, Korytkowski M, Mitrakou A (1991). “Hypoglycemia unawareness”. Endocr Rev. 12 (4): 356–71. doi:10.1210/edrv-12-4-356. PMID 1760993.
  5. ↑ Schultes B, Jauch-Chara K, Gais S, Hallschmid M, Reiprich E, Kern W; et al. (2007). “Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus”. PLoS Med. 4 (2): e69. doi:10.1371/journal.pmed.0040069. PMC 1808097. PMID 17326710.
  6. ↑ Gill GV, Woodward A, Casson IF, Weston PJ (2009). “Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes–the ‘dead in bed’ syndrome revisited”. Diabetologia. 52 (1): 42–5. doi:10.1007/s00125-008-1177-7. PMID 18972096.
  7. ↑ Marques JL, George E, Peacey SR, Harris ND, Macdonald IA, Cochrane T; et al. (1997). “Altered ventricular repolarization during hypoglycaemia in patients with diabetes”. Diabet Med. 14 (8): 648–54. doi:10.1002/(SICI)1096-9136(199708)14:8<648::AID-DIA418>3.0.CO;2-1. PMID 9272590.
  8. ↑ Weston PJ, Gill GV (1999). “Is undetected autonomic dysfunction responsible for sudden death in Type 1 diabetes mellitus? The ‘dead in bed’ syndrome revisited”. Diabet Med. 16 (8): 626–31. PMID 10477206.
  9. ↑ Luna J, Gilliland MG, Hewan-Lowe KO, Tanenberg RJ (2014). “Postmortem Diagnosis of Diabetic Ketoacidosis Presenting as the “Dead-in-Bed Syndrome““. Endocr Pract. 20 (7): e123–5. doi:10.4158/EP13473.CR. PMID 24641923.
  10. ↑ Riemsma R, Corro Ramos I, Birnie R, Büyükkaramikli N, Armstrong N, Ryder S; et al. (2016). “Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigmâ„¢ Veo system and the Vibeâ„¢ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation”. Health Technol Assess. 20 (17): v–xxxi, 1–251. doi:10.3310/hta20170. PMC 4809467. PMID 26933827.
  11. ↑ Health Quality Ontario (2018). “Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment”. Ont Health Technol Assess Ser. 18 (2): 1–160. PMC 5836597. PMID 29541282.
  12. ↑ Weisman A, Bai JW, Cardinez M, Kramer CK, Perkins BA (2017). “Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials”. Lancet Diabetes Endocrinol. 5 (7): 501–512. doi:10.1016/S2213-8587(17)30167-5. PMID 28533136.
  13. ↑ Waheed N, Butt M, Dayan C. Hypoglycaemia documented with real-time continuous glucose sensing in a case of ‘dead in bed’ syndrome. Practical Diabetes. 30(1):33–5. doi:10.1002/pdi.1737

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Robert G. Badgett, M.D.[2]