Sudden unexpected death syndrome (SUNDS) in the Mariana Islands

Abstract

SUNOS is a distinct clinical entity in previously healthy, young, Southeast Asian males. It is well known in the Philippines and lore recently recognized in the U.S., occuring in Indochinese refugees. The syndrome is characterized by the negative autopsy fingings, with no evidence of underlying disease and absence of toxic drug or alcohol levels. In the year 1988-9, four (4) cases of apparent SUNOS cane to coronial autopsy in the CNNI. Two (2) further cases whose circuistances were classic for SUNOS did not come to autopsy. Ml four cases were in previously healthy, male, Filipino construction workers, aged 23 to ‘0, who were either found dead in bed, or described by their colleagues as having nocturnal seizure activity consisting of gurgling, frothing, and tongue biting imediately prior to expiration. Autopsy findings were remarkable only in that no anatomic findings to account for death could be identified, Comprehensive seru» and urine drug analyses (performed on Guai) were negative for a11 common drugs screened for. One case revealed cardiomegaly (530g), though all shoved absence of significant atherosclerosis or grossly detectable structural cardiac anotaly, Termed ‘Bangungut’ in the Phillipines, 51 cases of SUNOS were reported betveen 1977 and 1982 in the U.S.A.(Baron.et al, JAMA 1983 250(21):2947-51) Migrants from S.E. Asia carry with then a predisposition to this syndrome, which appears to decline with longer residence in the new country. The mechanisa of death in SUNOS is believed to be ventricular fibrillation, possibly precipitated by sudden syapathetic discharge. Studies suggest at least some deaths ‘ay be associated with an abnormal cardiac conduction system. Other theories include sleep apnea and vagal reflex. Acute pancreatitis has been a finding in some series, but not our cases. Why the condition is virtually limited to males and seesingly sleep-triggered, has not been adequately explained. SUNOS has been associated with a family history, and other non-fatal sleep disorders, such as “night terrors.’ Stress and depression are believed to be predisposing factors. The four cases reported in the CNN1 occured in itinerant contract-labourers who had only been in the Commonwealth for a short time, less than the usual 2 year contract duration. Developing means of Identifying individuals, at risk for SUNDS is a challenge in countries with a sizeable Southeast Asian population.