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Nightmare Death

Night Terror AXIS I: 307.46
The rare sleep disorder goes by many names: night terrors, sleep terrors, pavor nocturnus, or AXIS I: 307.46 (The DSM’s code). It remains a medical mystery. What medical researchers do know is that night terrors are caused by an over-arousal of the central nervous system (CNS) during sleep. In children, this may be the result of the CNS still maturing — it has long been believed that the CNS’s maturation process ends in early childhood (although several recent studies suggest it may continue to develop through around age 25).

Medical Experts Seek Clues to 'Nightmare Deaths' That Strike Male Asian Refugees

January 11, 1987|LARRY DOYLE | United Press International

Since April, 1983 least 130 Southeast Asian refugees have left this world in essentially the same way. They cried out in their sleep. And then they died.

Medical authorities call this Asian Death Syndrome. The refugees have various names for it, one of them being Night Terror.

"In the Philippines, it's called bangungut, in Japan pokkuri, in Thailand something else," says Dr. Robert Kirschner. "But it all roughly translates as the same thing: nightmare death."

As a deputy Cook County medical examiner, Kirschner has investigated five nightmare deaths himself, including a Laotian father and son who died in a Northside Chicago apartment--in bed, asleep, and only 15 months apart.

"The people in their neighborhood are terrified," Kirschner says.

Sudden unexpected death syndrome, Sudden unexpected nocturnal death syndrome

Crow(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.

Spurred by curiosity and concern, Kirschner, an associate professor of pathology at the University of Chicago, undertook a systematic study of the problem. His results, based on data from the federal Centers for Disease Control and autopsies of 18 night terror victims, were recently reported in the Journal of the American Medical Assn.

Brugada syndrome
Brugada syndrome is a genetic disease that is characterised by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. It is named by the Spanish cardiologists Pedro Brugada and Josep Brugada. It is the major cause of sudden unexplained death syndrome (SUDS), also known as sudden adult death syndrome (SADS), and is the most common cause of sudden death in young men without known underlying cardiac disease in Thailand and Laos. Although the ECG findings of Brugada syndrome were first reported among survivors of cardiac arrest in 1989, it was only in 1992 that the Brugada brothers recognized it as a distinct clinical entity, causing sudden death by causing ventricular fibrillation (a lethal arrhythmia) in the heart.

The victims had much in common, Kirschner found, first and foremost that nothing seemed to be wrong with them before they suddenly died.

"These are all healthy men with no previous symptoms; the average age was 33," he says. "The situation is almost always the same. It only occurs in men and it only occurs in their sleep. The report is they cry out and die or are found dead the next morning."

Standard autopsies revealed little about the deaths, other than that they were caused by a sudden heart stoppage. Such an occurrence in Asians is mystifying, since their rates of ordinary cardiac disease and malfunction are extraordinarily low, primarily due to their low-fat diet.

Anomaly Turns Up

But detailed examinations of the victims' hearts, performed by Dr. Friedrich Eckner of the University of Illinois College of Medicine, turned up something strange.

All of the 18 hearts were slightly enlarged, and 17 showed defects in their conduction systems, the array of fibers that carries electronic impulses from the brain to the heart. The fibers were frayed and curled, as if, Kirschner says, "their hearts just shorted out."

It is Kirschner's theory that something at night, perhaps a random electronic discharge, and yes, perhaps a nightmare, overloaded these defective hearts, causing the sudden deaths. This makes the nightmare death all the more curious, since studies of whites who die suddenly has not shown the same defect.

Thus, Kirschner speculates, genetics probably plays a large role in the defect, which may be present from birth. Nightmare deaths are only found in certain Asian populations: Laos, Cambodia, Vietnam, as well as the Philippines and Japan. It has not been reported in China.

Suspects Stress as Factor

Stress is probably also a factor. Most of the deaths occurred within the first two years after the refugees arrived, and perhaps the strain of leaving home and coming to a strange land was too much for them, Kirschner says.

"The incidence appears to be dropping off now," he says. "So it does appear that maybe they're becoming more comfortable."

There is little that can be done to prevent nightmare death, given present knowledge, Kirschner says. "The best you can try to do is try to teach CPR (cardiopulmonary resuscitation) to relatives of those who are at high risk," he says. "But that's about it. People have to sleep."

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