Sudden unexplained death syndrome
Encyclopedia
Sudden unexpected death syndrome, or Sudden unexpected nocturnal death syndrome (SUNDS), is sudden unexpected death of adolescents and adults during sleep
.
Sudden unexplained death syndrome was first noted in 1977 among Hmong
refugees in the US. 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: In the Philippines, where it is referred to in the vernacular as bangungot, SUDS affects 43 per 100,000 per year among young Filipinos. Most of the victims are young males.
It has only been recently that the scientific world has begun to understand this syndrome. Victims of bangungot have not been found to have any organic heart diseases or structural heart problems.
However, cardiac activity during SUNDS episodes indicates irregular heart rhythms and ventricular fibrillation. The victim survives this episode if the heart's rhythm goes back to normal. Older Filipinos recommend wiggling the big toe of people experiencing this to encourage their heart to snap back to normal.
In the Philippines, most cases of bangungot have been linked with acute hemorrhagic pancreatitis
by Filipino medical personnel although the effect might have been due to changes in the pancreas during post-mortem autolysis. In Thailand and Laos, bangungot (or in their term, sudden adult death syndrome) is caused by the Brugada syndrome
.
(median age 33) and northeastern Thailand (where the population are mainly of Laotian descent). There is a strong hereditary component and the victims tend to die in their sleep. From experience bangungot is the sensation of the victim being fully aware of their surroundings however being unable to move. The victim tries to scream but cannot, and there seems to be a strain on their chest.
.
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), and one study has shown evidence for a long-QT syndrome in populations at risk. Thiamine deficiency is common in the risk population because of diet, and is also a cause of a prolonged QT-interval; but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.
Ongoing genetic studies by Spanish electrophysiologist Dr. Josep Brugada Terradellas show that SUDS results from mutations in the cardiac sodium channel gene. This means that it is a chromosomal problem, which is why it runs in families. Therefore doctors say that families who have kin that have suffered from or died of SUDS must see a heart specialist.
Bangungot is depicted in the Philippines as a mythological creature called batibat
. This hag-like
creature sits on the victim's face or chest so as to immobilize and suffocate him.
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
.
Sudden unexplained death syndrome was first noted in 1977 among Hmong
Hmong people
The Hmong , are an Asian ethnic group from the mountainous regions of China, Vietnam, Laos, and Thailand. Hmong are also one of the sub-groups of the Miao ethnicity in southern China...
refugees in the US. 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: In the Philippines, where it is referred to in the vernacular as bangungot, SUDS affects 43 per 100,000 per year among young Filipinos. Most of the victims are young males.
Causes
SUDS has been cloaked in superstition. In Thailand it is particularly believed to be linked to eating rice cakes. Filipinos believe ingesting high levels of carbohydrates just before sleeping causes bangungot.It has only been recently that the scientific world has begun to understand this syndrome. Victims of bangungot have not been found to have any organic heart diseases or structural heart problems.
However, cardiac activity during SUNDS episodes indicates irregular heart rhythms and ventricular fibrillation. The victim survives this episode if the heart's rhythm goes back to normal. Older Filipinos recommend wiggling the big toe of people experiencing this to encourage their heart to snap back to normal.
In the Philippines, most cases of bangungot have been linked with acute hemorrhagic pancreatitis
Acute pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment...
by Filipino medical personnel although the effect might have been due to changes in the pancreas during post-mortem autolysis. In Thailand and Laos, bangungot (or in their term, sudden adult death syndrome) is caused by the Brugada syndrome
Brugada syndrome
The Brugada syndrome is a genetic disease that is characterised by abnormal electrocardiogram findings and an increased risk of sudden cardiac death. It is named by the Spanish cardiologists Pedro Brugada and Josep Brugada...
.
Features
The condition appears to affect primarily young Hmong men from LaosLaos
Laos Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ Sathalanalat Paxathipatai Paxaxon Lao, officially the Lao People's Democratic Republic, is a landlocked country in Southeast Asia, bordered by Burma and China to the northwest, Vietnam to the east, Cambodia to the south and Thailand to the west...
(median age 33) and northeastern Thailand (where the population are mainly of Laotian descent). There is a strong hereditary component and the victims tend to die in their sleep. From experience bangungot is the sensation of the victim being fully aware of their surroundings however being unable to move. The victim tries to scream but cannot, and there seems to be a strain on their chest.
Pathology
The cause of this syndrome has been theorized to be a form of Brugada SyndromeBrugada syndrome
The Brugada syndrome is a genetic disease that is characterised by abnormal electrocardiogram findings and an increased risk of sudden cardiac death. It is named by the Spanish cardiologists Pedro Brugada and Josep Brugada...
.
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), and one study has shown evidence for a long-QT syndrome in populations at risk. Thiamine deficiency is common in the risk population because of diet, and is also a cause of a prolonged QT-interval; but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.
Ongoing genetic studies by Spanish electrophysiologist Dr. Josep Brugada Terradellas show that SUDS results from mutations in the cardiac sodium channel gene. This means that it is a chromosomal problem, which is why it runs in families. Therefore doctors say that families who have kin that have suffered from or died of SUDS must see a heart specialist.
Treatment
The only proven way to prevent death is by implantation of a cardiovertor defibrillator. Oral antiarrhythmics such as propranolol are ineffective.Folk beliefs
This phenomenon is well known among the Hmong people of Laos, who ascribe these deaths to a malign spirit, dab tsuam , 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.Bangungot is depicted in the Philippines as a mythological creature called batibat
Batibat
The Batibat or Bangungot is a vengeful demon found in Ilocano folklore. These demons were blamed as the cause of the fatal nocturnal disease called bangungot. A batibat takes the form of a huge, old, fat woman that resides in trees. They usually come in contact with humans when the tree that they...
. This hag-like
Hag
A hag is a wizened old woman, or a kind of fairy or goddess having the appearance of such a woman, often found in folklore and children's tales such as Hansel and Gretel. Hags are often seen as malevolent, but may also be one of the chosen forms of shapeshifting deities, such as the Morrígan or...
creature sits on the victim's face or chest so as to immobilize and suffocate him.
Names in different languages
- Bangungot (Philippines): The term originated from the TagalogTagalog languageTagalog is an Austronesian language spoken as a first language by a third of the population of the Philippines and as a second language by most of the rest. It is the first language of the Philippine region IV and of Metro Manila...
word meaning "to rise and moan in sleep". It is also the Tagalog word for nightmares. - Dab tsog (Laos)
- Lai Tai (Thailand)
- Pokkuri disease (Japan), hukuri
- Karabasan (Turkey) meaning "nightmare" or "dark heaviness"
See also
- Sudden cardiac deathSudden Cardiac DeathSudden cardiac death is natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms. Other forms of sudden death may be noncardiac in origin...
- Sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
- Sleep paralysisSleep paralysisSleep paralysis is paralysis associated with sleep that may occur in healthy persons or may be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occurs during REM sleep. When considered to be a...
- Yunnan Sudden Death SyndromeYunnan Sudden Death SyndromeYunnan Sudden Death Syndrome is a label used to define unexplained cases of cardiac arrest, which afflicted significant numbers of rural villagers in Yunnan province, in southwest China. Cases occurred almost always during the midsummer rainy season , at an altitude of 1800-2400m...