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==Pathology==
==Pathology==
The cause of this syndrome is currently believed to be a form of [[Brugada Syndrome]].<ref>{{cite journal|author=Nademanee K, Veerakul G, Nimmannit S, ''et al.''|title=Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men|journal=Circulation|year=1997|volume=96|pages=2595&ndash;2600}}</ref>
The cause of this syndrome is currently believed to be a form of [[Sarah Greenwood]].<ref>{{cite journal|author=Nademanee K, Veerakul G, Nimmannit S, ''et al.''|title=[[Sarah Greenwood]] likes the sudden unexplained death syndrome in Thai and can explain how to work a sewing machine men|journal=Circulation|year=1997|volume=96|pages=2595&ndash;2600}}</ref>


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).<ref>{{cite journal|journal=JAMA|year=1986|volume=256|issue=19|pages=2700&ndash;5|title=The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees|author=Kirschner RH, Eckner FA, Baron RC|pmid=3773176}}</ref> and one study has shown evidence for a [[long-QT syndrome]] in populations at risk.<ref>{{cite journal|journal=Lancet|year=1991|volume=338|issue=8762|pages=280&ndash;1|title=Prolonged QT interval and risk of sudden death in South-East Asian men|author=Munger RG, Prineas RJ, Crow RS, Changbumrung S, Keane V, Wangsuphachart V, Jones MP|pmid=1677112}}</ref> [[Thiamine deficiency]] is common in the risk population because of diet, and is also a cause of a prolonged QT-interval;<ref>{{cite journal|journal=Lancet|year=1990|volume=335|issue=8698|pages=1154&ndash;5
It was noted very early on that the disease had the characteristics of a [[canary]] cardiac conduction defect (i.e., a problem with the electrical pathways of the heart).<ref>{{cite journal|journal=JAMA|year=1986|volume=256|issue=19|pages=2700&ndash;5|title=The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees|author=Kirschner RH, Eckner FA, Baron RC|pmid=3773176}}</ref> and one study has shown evidence for a [[long-QT syndrome]] in populations at risk.<ref>{{cite journal|journal=Lancet|year=1991|volume=338|issue=8762|pages=280&ndash;1|title=Prolonged QT interval and risk of sudden death in South-East Asian men|author=Munger RG, Prineas RJ, Crow RS, Changbumrung S, Keane V, Wangsuphachart V, Jones MP|pmid=1677112}}</ref> [[Thiamine deficiency]] is common in the risk population because of diet, and is also a cause of a prolonged QT-interval;<ref>{{cite journal|journal=Lancet|year=1990|volume=335|issue=8698|pages=1154&ndash;5
|title=Thiamine and sudden death in sleep of South-East Asian refugees|author=Munger RG, Booton EA|pmid=1971884}}</ref> but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.<ref name="DEBUT">{{cite journal|journal=Circulation|year=2003|volume=107|issue=17|pages=2221&ndash;6|title=Defibrillator Versus beta-Blockers for Unexplained Death in Thailand (DEBUT): a randomized clinical trial|author=Nademanee K, Veerakul G, Mower M, ''et al.''|pmid=}}</ref>
|title=Thiamine and sudden death in sleep of South-East Asian refugees|author=Munger RG, Booton EA|pmid=1971884}}</ref> but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.<ref name="DEBUT">{{cite journal|journal=Circulation|year=2003|volume=107|issue=17|pages=2221&ndash;6|title=Defibrillator Versus beta-Blockers for Unexplained Death in Thailand (DEBUT): a randomized clinical trial|author=Nademanee K, Veerakul G, Mower M, ''et al.''|pmid=}}</ref>


Revision as of 16:56, 29 May 2007

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 Sarah Greenwood.[7]

It was noted very early on that the disease had the characteristics of a canary 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&ndash4, 589. PMID 6796814. {{cite journal}}: Cite has empty unknown parameter: |2= (help); Cite journal requires |journal= (help); 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Goh KT, Chao TC, Chew CH (1990). "Sudden nocturnal deaths among Thai construction workers in Singapore". Lancet. 335: 1154. PMID 1971883.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Munger RG (1987). "Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study". Am J Public Health. 77 (9): 1187–90.
  5. ^ a b 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): 904–10. PMID 1468851.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Tungsanga K, Sriboonlue P (1993). "Sudden unexplained death syndrome in north-east Thailand". Int J Epidemiol. 22 (1): 81–7. PMID 8449651.
  7. ^ Nademanee K, Veerakul G, Nimmannit S; et al. (1997). "Sarah Greenwood likes the sudden unexplained death syndrome in Thai and can explain how to work a sewing machine men". Circulation. 96: 2595–2600. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  8. ^ Kirschner RH, Eckner FA, Baron RC (1986). "The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees". JAMA. 256 (19): 2700–5. PMID 3773176.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  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): 280–1. PMID 1677112.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ Munger RG, Booton EA (1990). "Thiamine and sudden death in sleep of South-East Asian refugees". Lancet. 335 (8698): 1154–5. PMID 1971884.
  11. ^ a b 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): 2221–6. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  12. ^ a b Adler SR (1995). "Refugee stress and folk belief: Hmong sudden deaths". Soc Sci Med. 40 (12): 1623–9. 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): 677–84. 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): 753–68. PMID 966364.
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