Sudden unexplained death syndrome

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Sudden unexplained death syndrome was first noted in 1977 among Hmong refugees in the US.[1][2] The disease was again noted in Singapore, when a retrospective survey of records showed that 230 otherwise healthy Thai men died suddenly of unexplained causes between 1982 and 1990:[3] publication of this data provoked a diplomatic incident.

Features

The condition appears to affect primarily young Hmong men from Laos (median age 33)[4] and northeastern Thailand (where the population are mainly of Laotian descent).[5][6] There is a strong hereditary component and the victims tend to die in their sleep.

Survivors describe a feeling of intense fear and paralysis. There is a sensation of pressure in the chest, the presence of an alien being in the room and altered sensation.

Pathology

The cause of this syndrome is currently believed to be a form of Brugada Syndrome.[7]

It was noted very early on that the disease had the characteristics of a familial cardiac conduction defect (i.e., a problem with the electrical pathways of the heart).[8] and one study has shown evidence for a long-QT syndrome in populations at risk.[9] Thiamine deficiency is common in the risk population because of diet, and is also a cause of a prolonged QT-interval;[10] but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.[11]

Treatment

The only proven way to prevent death is by implantation of a cardiovertor defibrillator. Oral antiarrhythmics such as propranolol are ineffective.[11]

Folk beliefs

This phenomenon is well known among the Hmong people of Laos,[12] who ascribe these deaths to a malign spirit, dab tsog (pronounced "da cho"), said to take the form of a jealous woman. Hmong men may even go to sleep dressed as women so as to avoid the attentions of this spirit.

Synonyms

  • Sudden Unexpected Nocturnal Death Syndrome (SUNDS)
  • Bangungut (Phillipines)[13]
  • Dab tsog (Laos)[12]
  • Laitai (Thailand)[5]
  • Pokkuri disease (Japan)[14]

References

  1. Centers for Disease Control (CDC) (1981). "Sudden, unexpected, nocturnal deaths among Southeast Asian refugees". 30 (47): 581&ndash, 4, 589. PMID 6796814. Text "MMWR Morb Mortal Wkly Rep" ignored (help)
  2. Parrish RG, Tucker M, Ing R, Encarnacion C, Eberhardt M (1987). "Sudden unexplained death syndrome in Southeast Asian refugees: a review of CDC surveillance". MMWR CDC Surveill Summ. 36 (1): 43SS–53SS. PMID 3110586.
  3. Goh KT, Chao TC, Chew CH (1990). "Sudden nocturnal deaths among Thai construction workers in Singapore". Lancet. 335: 1154. PMID 1971883.
  4. Munger RG (1987). "Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study". Am J Public Health. 77 (9): 1187&ndash, 90.
  5. 5.0 5.1 Tatsanavivat P, Chiravatkul A, Klungboonkrong V, Chaisiri S, Jarerntanyaruk L, Munger RG, Saowakontha S (1992). "Sudden and unexplained deaths in sleep (Laitai) of young men in rural northeastern Thailand". Int J Epidemiol. 21 (5): 904&ndash, 10. PMID 1468851.
  6. Tungsanga K, Sriboonlue P (1993). "Sudden unexplained death syndrome in north-east Thailand". Int J Epidemiol. 22 (1): 81&ndash, 7. PMID 8449651.
  7. Nademanee K, Veerakul G, Nimmannit S; et al. (1997). "Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men". Circulation. 96: 2595&ndash, 2600.
  8. Kirschner RH, Eckner FA, Baron RC (1986). "The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees". JAMA. 256 (19): 2700&ndash, 5. PMID 3773176.
  9. Munger RG, Prineas RJ, Crow RS, Changbumrung S, Keane V, Wangsuphachart V, Jones MP (1991). "Prolonged QT interval and risk of sudden death in South-East Asian men". Lancet. 338 (8762): 280&ndash, 1. PMID 1677112.
  10. Munger RG, Booton EA (1990). "Thiamine and sudden death in sleep of South-East Asian refugees". Lancet. 335 (8698): 1154&ndash, 5. PMID 1971884.
  11. 11.0 11.1 Nademanee K, Veerakul G, Mower M; et al. (2003). "Defibrillator Versus beta-Blockers for Unexplained Death in Thailand (DEBUT): a randomized clinical trial". Circulation. 107 (17): 2221&ndash, 6.
  12. 12.0 12.1 Adler SR (1995). "Refugee stress and folk belief: Hmong sudden deaths". Soc Sci Med. 40 (12): 1623&ndash, 9. PMID 7660175.
  13. Munger RG, Booton EA (1998). "Bangungut in Manila: sudden and unexplained death in sleep of adult Filipinos". Int J Epidemiol. 27 (4): 677&ndash, 84. PMID 9758125.
  14. Gotoh K (1976). "A histopathological study on the conduction system of the so-called "Pokkuri disease" (sudden unexpected cardiac death of unknown origin in Japan". Jpn Circ J. 40 (7): 753&ndash, 68. PMID 966364.

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