Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes--the 'dead in bed' syndrome revisited.
OBJECTIVE
Sudden nocturnal death in type 1 diabetes ('dead in bed' syndrome) is thought to be due to ECG QT prolongation with subsequent ventricular tachyarrhythmia in response to nocturnal hypoglycaemia. We investigated this theoretical mechanism using continuous ECG and continuous glucose monitoring in a group of patients with type 1 diabetes.


METHODS
Twenty-five patients with type 1 diabetes (age 20-50 years) underwent two separate 24 h ECG and continuous glucose monitoring periods. Patients were fully ambulant and carried out normal daily activities.


RESULTS
There were 13 episodes (26% of recordings) of nocturnal hypoglycaemia, eight of <2.2 mmol/l and five of 2.2-3.4 mmol/l. Corrected QT interval (QTc) was longer during nocturnal hypoglycaemia compared with normoglycaemic control periods (445 +/- 40 vs 415 +/- 23 ms; p = 0.037). Cardiac rate and rhythm disturbances (excluding sinus tachycardia) were seen in eight of the 13 nocturnal hypoglycaemia episodes (62%). These were sinus bradycardia (<40 beats/min; three episodes), ventricular ectopics (three episodes), atrial ectopics (one) and P wave abnormalities (one).


CONCLUSIONS
This study demonstrates QTc prolongation and cardiac rate/rhythm disturbances in response to episodes of nocturnal hypoglycaemia in ambulant patients with type 1 diabetes. This may support an arrhythmic basis for the 'dead in bed' syndrome.
Gill
G V
GV
Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK. g.gill@liv.ac.uk
Woodward
A
A
Casson
I F
IF
Weston
P J
PJ
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000503:physiopathology*; D001786:Blood Glucose / Q000032:analysis*; D001919:Bradycardia / Q000453:epidemiology; D002940:Circadian Rhythm / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology*; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D007003:Hypoglycemia / Q000503:physiopathology*; D008133:Long QT Syndrome / Q000453:epidemiology; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D008991:Monitoring, Physiologic / Q000379:methods; D012890:Sleep / Q000502:physiology*; D013612:Tachycardia, Ectopic Atrial / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose