Sudden unexplained death syndrome

Sudden unexpected death syndrome (SUDS) or Sudden unexpected nocturnal death syndrome (SUNDS) is sudden unexpected death of adolescents and adults during sleep.Fact|date=September 2008 It is rarely observed in the Western world, and appears to occur more commonly among young men in East and Southeast Asian countries.Fact|date=September 2008 While experiencing this, the person is aware that he is dreaming but feels like there is something that stops him from moving and awaking.Fact|date=April 2008

It is also known as "Lai-Tai".cite journal |author=Himmunngan P, Sangwatanaroj S, Petmitr S, Viroonudomphol D, Siriyong P, Patmasiriwat P |title=HLa-class II (DRB & DQB1) in Thai sudden unexplained death syndrome (Thai SUDS) families (Lai-Tai families) |journal=Southeast Asian J. Trop. Med. Public Health |volume=37 |issue=2 |pages=357–65 |year=2006 |month=March |pmid=17124999 |doi= |url=]

Sudden unexplained death syndrome was first noted in 1977 among Hmong refugees in the US. [cite journal|year=1981|volume=30|issue=47|pages=581–4,589|title=Sudden, unexpected, nocturnal deaths among Southeast Asian refugees|author=Centers for Disease Control (CDC)
pmid=6796814|unused_data=MMWR Morb Mortal Wkly Rep|
] [cite journal|journal=MMWR CDC Surveill Summ|year=1987|volume=36|issue=1|pages=43SS–53SS|title=Sudden unexplained death syndrome in Southeast Asian refugees: a review of CDC surveillance|author=Parrish RG, Tucker M, Ing R, Encarnacion C, Eberhardt M|pmid=3110586] 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: [cite journal|author=Goh KT, Chao TC, Chew CH|title=Sudden nocturnal deaths among Thai construction workers in Singapore|journal=Lancet|year=1990|volume=335|pages=1154|pmid=1971883|doi=10.1016/0140-6736(90)91153-2] publication of this data provoked a diplomatic incident.


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 SUDS episodes indicates irregular heart rhythms and ventricular fibrillation. The victim survives this episode if the heart's rhythm goes back to normal. Older folks in the Philippines recommend trying wiggling the big toe while experiencing this to snap back.

In the Philippines, most cases of "bangungot" have been linked with acute hemorrhagic pancreatitis,Fact|date=September 2008 whereas in Thailand and Laos, "bangungot" (or in their term, sudden adult death syndrome) is caused by the Brugada syndrome. [ [ (link broken as of 03 October, 2007).] ]


The condition appears to affect primarily young Hmong men from Laos (median age 33) [cite journal|journal=Am J Public Health|year=1987|volume=77|issue=9|pages=1187–90|title=Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study|author=Munger RG] and northeastern Thailand (where the population are mainly of Laotian descent).cite journal|journal=Int J Epidemiol|year=1992|volume=21|issue=5|pages=904–10|title=Sudden and unexplained deaths in sleep (Laitai) of young men in rural northeastern Thailand|author=Tatsanavivat P, Chiravatkul A, Klungboonkrong V, Chaisiri S, Jarerntanyaruk L, Munger RG, Saowakontha S|pmid=1468851|doi=10.1093/ije/21.5.904] [cite journal|journal=Int J Epidemiol|year=1993|volume=22|issue=1|pages=81–7|title=Sudden unexplained death syndrome in north-east Thailand|author=Tungsanga K, Sriboonlue P|pmid=8449651|doi=10.1093/ije/22.1.81] 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.


The cause of this syndrome has been theorized to be a form of Brugada Syndrome. [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=2595–2600] cite journal |author=Vatta M, Dumaine R, Varghese G, "et al" |title=Genetic and biophysical basis of sudden unexplained nocturnal death syndrome (SUNDS), a disease allelic to Brugada syndrome |journal=Hum. Mol. Genet. |volume=11 |issue=3 |pages=337–45 |year=2002 |month=February |pmid=11823453 |doi= |url=]

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). [cite journal|journal=JAMA|year=1986|volume=256|issue=19|pages=2700–5|title=The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees|author=Kirschner RH, Eckner FA, Baron RC|pmid=3773176|doi=10.1001/jama.256.19.2700] and one study has shown evidence for a long-QT syndrome in populations at risk. [cite journal|journal=Lancet|year=1991|volume=338|issue=8762|pages=280–1|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|doi=10.1016/0140-6736(91)90419-P] Thiamine deficiency is common in the risk population because of diet, and is also a cause of a prolonged QT-interval; [cite journal|journal=Lancet|year=1990|volume=335|issue=8698|pages=1154–5
title=Thiamine and sudden death in sleep of South-East Asian refugees|author=Munger RG, Booton EA|pmid=1971884
] but proof that inducible ventricular arrhythmia is the cause of this disease came only with the publication of the DEBUT trial in 2003.cite journal|journal=Circulation|year=2003|volume=107|issue=17|pages=2221–6|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=|doi=10.1161/01.CIR.0000066319.56234.C8]

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. Thus, doctors say that families who have kin that have suffered from or died of SUDS must see a heart specialist.


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,cite journal|journal=Soc Sci Med|year=1995|volume=40|issue=12|pages=1623–9|title=Refugee stress and folk belief: Hmong sudden deaths|author=Adler SR|pmid=7660175|doi=10.1016/0277-9536(94)00347-V] 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.

Every Filipino family knows someone who has been killed by the "bangungot." In Filipino folklore, bangungot is personified as a fat man who creeps into the bedroom of sleeping men and sits on their faces to suffocate them.

Bangungot is also depicted in the Philippines as a mythological creature called batibat. This hag-like creature sits on the victim's face so as to immobilize and suffocate him.

Names in different languages

* "Bangungot" (Philippines) [cite journal|journal=Int J Epidemiol|year=1998|volume=27|issue=4|pages=677–84|title=Bangungut in Manila: sudden and unexplained death in sleep of adult Filipinos|author=Munger RG, Booton EA|pmid=9758125|doi=10.1093/ije/27.4.677] : The term originated from the Tagalog word meaning "nightmare." The root of this word comes from two Tagalog words "bangon", which means to rise or to be awake and "ungul" which means to moan.Fact|date=January 2008
* "Dab tsog" (Laos)
* "Laitai" (Thailand)
* "Pokkuri" disease (Japan) [cite journal|journal=Jpn Circ J|year=1976|volume=40|issue=7|pages=753–68|title=A histopathological study on the conduction system of the so-called "Pokkuri disease" (sudden unexpected cardiac death of unknown origin in Japan|author=Gotoh K|pmid=966364] , "hukuri"


Further reading

last1 = Tan
first1 = Michael
title = Bangungot
newspaper = Philippine Daily Inquirer
date = 29 August, 2000
year = 2000
url =

last1 = Tan
first1 = Michael
title = Revisiting ‘bangungot’
newspaper = Philippine Daily Inquirer
date = 1 April, 2002
year = 2002
url =

last1 = Tan
first1 = Michael
title = 'Bangungot', the sequel
newspaper = Philippine Daily Inquirer
date = 18 April, 2002
year = 2002
url =

last1 = Agence France Presse
first1 =
title = Sleeping death syndrome terrorises young men
newspaper = The Borneo Post
date = 8 April, 2002
year = 2002
url =

ee also

* Brugada syndrome
* Sleep apnea

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