Sudden unexpected death syndrome
|Classification and external resources|
Sudden unexpected death syndrome, Sudden unexpected nocturnal death syndrome (SUNDS), Sudden arrhythmic cardiac death Syndrome (SADS), Sudden Unknown Death Syndrome, Sudden Adult Death Syndrome or Bed Death is sudden unexpected death of adolescents and adults, many 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, SUNDS affects 43 per 100,000 per year among young Filipinos. Most of the victims are young males.
In about 1 in every 20 cases of sudden cardiac death, no definite cause of death can be found, even after the heart has been examined by an expert cardiac pathologist. This is then called Sudden Arrhythmic Death Syndrome. In the past it has also been called Sudden Adult Death Syndrome or Sudden Death Syndrome but, because it affects children too, the term Sudden Arrhythmic Death Syndrome is now used. It is thought that cot death (Sudden Infant Death Syndrome, or SIDS) may be partly due to the same causes responsible for SADS.
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.
Research suggests that sudden death may be caused infrequently by conditions such as fits (epilepsy) and severe asthma attacks. Pulmonary embolus (a clot to the lungs) has become better known recently due to its association with staying immobile for long periods during air travel (see page 32). It can cause a sudden collapse and a rapid death.
The conditions responsible for SADS cause a cardiac arrest by bringing on a 'ventricular arrhythmia' (a disturbance in the heart's rhythm), even though the person has no structural heart disease. There is a group of relatively rare diseases called ion channelopathies that affect the electrical functioning of the heart without affecting the heart's structure. This means that they can only be detected in life and not at post-mortem. Ion channelopathies are probably responsible for 4 in every 10 cases of SADS. There are several different types of ion channelopathies including, 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. 
In most of the inherited conditions known to cause SADS, mutations of specific genes have been detected and are thought to cause a specific disease. More research is required in this area. As research progresses, more genes will be identified and there will be better tools to decide whether the impact of a mutation causes a disease. 
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. 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.
This phenomenon is well known among the Hmong people of Laos, who ascribe these deaths to a malign spirit, dab tsuam (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.
Hmong people believed that rejecting the role of becoming a shaman, they are taken into the spirit world.
Bangungot is depicted in the Philippines as a mythological creature called batibat or bangungot. This hag-like creature sits on the victim's face or chest so as to immobilize and suffocate him. When this occurs, the victim usually experiences paralysis. It's said that one should bite their tongue and wiggle their toes to try to get out of this paralysis or they may die from suffocation.
Names in different languages
- Bangungot and "Uom" (Philippines): The term originated from the Tagalog word meaning "to rise and moan in sleep". It is also the Tagalog word for nightmare.
- In English, the phenomenon of sleep paralys is also known as Old Hag.
- Dab tsog (Laos)
- Lai Tai (Thailand) (Thai: ใหลตาย; meaning "sleep and die")
- "agmong" (Korea)
- Pokkuri disease (Japan), fukuri...
- Ya Thoom Arabic
- Albarsty (Kyrgyzstan) (Kyrgyz: албарсты)
- "Documentary maker died of sudden adult death syndrome, coroner rules" by Caroline Davies, The Guardian, December 12, 2013, Retrieved 2013-12-31
- Also known as SUDS. See: Reddy PR, Reinier K, Singh T, Mariani R, Gunson K, Jui J, Chugh SS. Physical activity as a trigger of sudden cardiac arrest: The Oregon Sudden Unexpected Death Study. Int J Cardiol. 2008
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