Monday, April 3, 2017

Bangungot: Sleep death in young men

The Inquirer article on young men who die in their sleep.

The identification of young males—aged 25 to 44, presumably healthy, without any known cardiac illness—as at-risk individuals is also consistent with international scientific reports on the Brugada Syndrome. Southeast Asian males seem to have an increased predisposition to it. Similar cases are also seen in Pacific Rim countries and Polynesian populations where Southeast Asians have migrated. 
a sudden arrhythmia?

Some medicines like good old quinidine have been shown to be effective in preventing life-threatening arrhythmias, but for those who can afford it, an implantable cardiac defibrillator (ICD), similar to an artificial pacemaker battery, is surgically implanted just beneath the skin layer on the chest. It’s hooked to the heart and gives it a mild “shock” (defibrillate) whenever it goes into a life-threatening heartbeat.


A young man in his 20's just died of this in our barangy... our cook's son probably died of it also, but he was dizzy and went to the doctors and collapsed. This happened before, and he recovered, but this time it took to long to transfer him so he died. Sigh.  

this runs in our family also: Lolo's brother and nephew both had sudden cardiac deaths. (His father also died young, but we think it was from TB..)

Wikipedia article here.

The cause of sudden death in Brugada syndrome is ventricular fibrillation (VF). The average age of death is 41. According to clinical reports, sudden death in people with Brugada syndrome most often happens during sleep. The episodes of syncope (fainting) and sudden death (aborted or not) are caused by fast polymorphic ventricular tachycardias or ventricular fibrillation. These arrhythmias appear with no warning. 
There are several syndromes that cause this, and some genetic testing, and an EKG might be a good way to screen.

But the treatment, an implantable defibrillator, is too expensive for ordinary folks, and alas there is no push to screen for the problem.

this first came to light in US medical journals when some Cambodian refugee men dropped dead. The anti war folks blamed it on Russian "yellow rain"..., but anyone with Asian relatives would be aware of the syndrome... 

More HERE. on what drugs to avoid if you have the syndrome.

HealthMatrix discusses the folk lore behind the syndrome.

In the English-speaking world, we talk about the Night Hag and similar apparitions (see pp38–40). These terrifying beings are glimpsed in the darkness of nightmare, pressing down on their victims and preventing them from breathing. Their attacks, though scary, are generally harmless, whereas the nightmare demons of the Far East can be lethal. In Japan, this type of death is known as pok-kuri; the Filipinos call it bangungot or batibat; and the Hmong people of Vietnam and Laos call it tsob tsuang. In Thailand, the being to fear is the phi am or ‘widow ghost’ who comes to steal away the souls of young men. Some men defend themselves from phi am by wearing lipstick at night, so that the ghost mistakes them for women and leaves them alone.
Although he discovered references to the condition in Filipino medical literature as far back as 1917, Dr Aponte could draw no conclusions about the nightmare deaths. The same condition was later documented among refugees from South-East Asia, and in 1981 some 38 victims had been recorded in the US, most of them Hmong. The term Nightmare Death Syndrome was coined, which was later changed to Sudden Unexplained Nocturnal Death (SUND) or Sudden Unexplained Death Syndrome (SUDS) (see FT48:25, 55:15). The immediate cause of death was cardiac arrest. But why had the men’s hearts failed when there was seemingly nothing wrong with them?
In folklore, a “mare” or “nightmare” is not an awful dream, but rather a supernatural being that crushes a sleeper’s body by sitting on it. Another related term is hag-riding which implies a frightening feeling of being held immobile in bed, often as if by a heavy weight pressing on one’s stomach or chest and it is said that it might be accompanied by the sense of an alien presence, and by visual hallucinations. In folklore, it was thought of as a magical attack, whether it was a demonic incubus, ghost, harmful fairy, or witch depending on culture and time period.

if you have heard the folk advice not to wake someone up suddenly when they are asleep, this syndrome is the reason.

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