Sudden arrhythmic death syndrome (SADS), also known as sudden adult death syndrome, sudden unexpected/unexplained death syndrome (SUDS) or sudden unexpected/unexplained nocturnal death syndrome(SUNDS), is a sudden unexpected death of adolescents and adults, mainly during sleep.[1][2] Sudden unexpected death syndrome is rare in most areas around the world. This syndrome occurs in populations that are culturally and genetically distinct and people who leave the population carry with them the vulnerability to sudden death during sleep. Sudden unexplained death syndrome was first noted in 1977 among southeast Asian Hmong refugees in the US.[3][4] 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:[5] In the Philippines, where it is referred to in the vernacular as bangungot, which means "to rise and to moan in sleep" and inJapan it is known as Pokkuri which means “sudden and unexpectedly ceased phenomena”.
A Tokyo Medical Examiner reported that every year several hundred evidently healthy men are found dead in their beds in the Tokyo District alone. These observations indicate that the recent sudden deaths of Southeast Asian refugees are not a new occurrence, but rather an ongoing pattern of sudden deaths that appears in mainland Southeast Asia. Sudden unexpected death syndrome once caused more deaths among males than car accidents in Southeast Asia.[6] Most of those affected are young males.[7] Although there has been a significant amount of research on this topic, scientists have not been able to determine the exact cause; it is thought to be the body’s failure to accurately coordinate electrical signals that cause the heart to beat and the blood to keep flowing. This syndrome is also very difficult to detect even with extensive tests and an electrocardiograph.
Causes
No cause of death is found, even after extensive examination in 5% of cases.
A sudden death in a young person can be caused by heart disease (including cardiomyopathy, congenital heart disease, myocarditis, genetic connective tissue disorders, mitral valve prolapse or conduction disease), medication-related causes or other causes.
Rare diseases called channelopathies may play a role such as long QT syndrome (LQTS), Brugada syndrome CPVT (catecholaminergic polymorphic ventricular tachycardia), PCCD (progressive cardiac conduction defect), early repolarisation syndrome, mixed sodium channel disease, and short QT syndrome.
Medical examiners have taken into account various factors, such as nutrition, toxicology, heart disease, metabolism, and genetics. Although there is no real known definite cause, extensive research showed people 18 years or older were found to have suffered from a hypertrophic cardiomyopathy, a condition in which the heart muscle becomes oddly thickened without any obvious cause. This was the most commonly identified abnormality in sudden death of young adults. In the instances where people experience sudden death, it is most commonly found that they were suffering from CAD (Coronary Artery Disease) or ASCAD (Atherosclerotic Coronary Artery Disease), or any level of stress.[14]However, studies reveal that people experienced early symptoms within the week before the terminal event such as chest pain at ~52% of victims, dyspnea at ~22%, syncope at ~7% and ~19% who experienced no symptoms. Scientists have also associated this syndrome with the gene SCN5A that is mutated and affects the function of the heart. However, all autopsies done on victims who suffered from this syndrome came back negative.
In some cultures, SUNDS has been cloaked in superstition. Many 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.[citation needed] 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.
Study background[edit]
Laotian-Hmong`s were chosen for the study because they had one of the highest sudden death rates while sleeping in the United States. They were originally from Southern China and the highlands of North Vietnam, Laos, and Thailand. The location that was picked for this study was inBan Vinai in the Loei Province, which is approximately 15 kilometers from the Lao border. This study took place between October 1982 and June 1983 as this syndrome became more of a relevant pressing issue. Ban Vinai was the location chosen because it had 33,000 refugees in 1982, which was the largest population of victims.[8] Because this syndrome was occurring most commonly in those particular men, researchers found it most beneficial and effective to study the population in which they migrated from instead of studying victims and populations in the U.S. Because of religious limitations the Hmong men in Ban Vinai were not allowed to receive autopsies. Therefore, the only results and research obtained were victims outside of their religion or geographical area. An interview was arranged with the next of kin who lived with the victim, witnessed the death, or found the body. The interviews were open ended and allowed the person who was next of kin to describe what they witnessed and what preceding events they thought were relevant to the victim`s death. The interviewers also collected information such as illness history, the circumstances of the death, demographic background, and history of any sleep disturbances. A genealogy was then created which included all the relatives and their vital status and circumstances of death[8]
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