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Sudden Nocturnal Death in Southeast Asian Refugees-Reply

Robert H. Kirschner, MD; Friedrich A. O. Eckner, MD; Roy C. Baron, MD
JAMA. 1987;257(11):1473. doi:10.1001/jama.1987.03390110049017.
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In Reply.—  Dr Coleman suggests sleep apnea syndrome as a cause of sudden unexplained nocturnal death syndrome (SUNDS) in Southeast Asian refugees. We found no evidence to suggest this etiology. As discussed in our article, the hearts that we examined were all from SUNDS victims whose deaths had been reported to the Centers for Disease Control, Atlanta, and there was a thorough investigation of each case by the Centers for Disease Control. The epidemiologic aspects of this disorder have been previously reported,1 and, specifically, evidence for sleep apnea syndrome was lacking. "Most were considered sound sleepers by their spouses, who reported no earlier episodes of respiratory distress or prolonged apnea during sleep, and none experienced daytime hypersomnolence."1Although cardiomegaly was a common finding at autopsy, there was no morphologic evidence for either pulmonary hypertension or systemic hypertension.Furthermore, no anatomic abnormality of the upper airways that might produce


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