November 1, 1985

Sudden Unexplained Nocturnal Deaths

Author Affiliations

Medical Department Stadtspital Waid Zurich

JAMA. 1985;254(17):2408. doi:10.1001/jama.1985.03360170048010

To the Editor.—  Sudden unexplained nocturnal deaths (SUND) among Southeast Asian males, as described in a CASE REPORT in The Journal,1 is known in Japan as pok-kuri disease and in the Philippines as bangungut.2 In a recent pathological study of SUND from Japan,3 fulminant deletion of myoglobin from myocardial fibers in multiple disseminated foci, with deposition of myoglobin in the interstitium, was found. It was speculated that the multiple necroses were due to functional spasm of main coronary branches in a state of vagotonia during sleep. The terminal event might be ventricular fibrillation caused by diffusion of potassium from necrotic sites. Another communication suggested that there may be congenital lesions of the conduction system in victims of SUND.4Because subjects prone to SUND are healthy men of younger age, screening of the East Asian (immigrant) population seems impossible. Awareness by relatives and prompt delivery of resuscitation