Abstract
The mechanism of dead-in-bed syndrome (DBS), a rare but devastating condition that mainly affects young type 1 diabetes patients, remains mysterious. A new theory is proposed to explain this syndrome. This theory suggests that repeated episodes of hypoglycaemia-induced adaptation in orexin-A neurons cause (i) defective awakening and (ii) hypotonia of upper airway muscles during sleep. Consequently, due to the combined effect of these factors, long-term exposure of intermittent hypoxia occurs, leading to a combination of factors - such as depression of ventilation, increase in sympathetic tone, fluctuations in intrathoracic pressure and cardiac arrhythmias - these in conjunction with an underlying cardiovascular pathology (genetically inherited or acquired) cause cardio-respiratory failure and thus sudden death during sleep. This mechanism can be generalized to explain other cases of sudden unexplained nocturnal deaths including sudden infant deaths (SIDs).
Keywords: Hypoglycaemia, Glucose, Orexin, Arousal, Sleep apnoea, Sudden death
Current Diabetes Reviews
Title: The Mechanism of Dead-in-Bed Syndrome and Other Sudden Unexplained Nocturnal Deaths
Volume: 5 Issue: 4
Author(s): B. Parekh
Affiliation:
Keywords: Hypoglycaemia, Glucose, Orexin, Arousal, Sleep apnoea, Sudden death
Abstract: The mechanism of dead-in-bed syndrome (DBS), a rare but devastating condition that mainly affects young type 1 diabetes patients, remains mysterious. A new theory is proposed to explain this syndrome. This theory suggests that repeated episodes of hypoglycaemia-induced adaptation in orexin-A neurons cause (i) defective awakening and (ii) hypotonia of upper airway muscles during sleep. Consequently, due to the combined effect of these factors, long-term exposure of intermittent hypoxia occurs, leading to a combination of factors - such as depression of ventilation, increase in sympathetic tone, fluctuations in intrathoracic pressure and cardiac arrhythmias - these in conjunction with an underlying cardiovascular pathology (genetically inherited or acquired) cause cardio-respiratory failure and thus sudden death during sleep. This mechanism can be generalized to explain other cases of sudden unexplained nocturnal deaths including sudden infant deaths (SIDs).
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Cite this article as:
Parekh B., The Mechanism of Dead-in-Bed Syndrome and Other Sudden Unexplained Nocturnal Deaths, Current Diabetes Reviews 2009; 5 (4) . https://dx.doi.org/10.2174/157339909789804387
DOI https://dx.doi.org/10.2174/157339909789804387 |
Print ISSN 1573-3998 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6417 |
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