Sudden Nocturnal Death in Southeast Asian Refugees

To the Editor.—  I read with interest the article entitled "Cardiac Pathology of Sudden Unexplained Nocturnal Death in Southeast Asian Refugees," by Kirschner et al.¹ I believe a possible clinical explanation for the death of these patients exists.Sleep apnea syndrome would explain almost all of the issues raised in this article. Sleep apnea syndrome is a disease with a significant male preponderance, and all of the patients autopsied in this series were male. The authors postulate that the patients died of a fatal cardiac arrhythmia, and arrhythmias are known to occur as a direct result of hemoglobin desaturation during apneic events. The autopsied hearts were grossly hypertrophied. The authors discuss the possibility of systemic hypertension in this article. Both systemic and pulmonary hypertension are well-known components of sleep apnea syndrome.One of the frightening aspects of evaluating patients with sleep-related breathing disorders is that we evaluate only the