0
December 2, 1983, Vol 250, No. 21 >
ARTICLE | December 2, 1983

Sudden Death Among Southeast Asian Refugees: Title and subTitle BreakAn Unexplained Nocturnal Phenomenon FREE

Roy C. Baron, MD; Stephen B. Thacker, MD; Leo Gorelkin, MD; Andrew A. Vernon, MD; William R. Taylor, MD, MPH; Keewhan Choi, PhD
[+] Author Affiliations

Reprint requests to Division of Surveillance and Epidemiologic Studies, Epidemiology Program Office, Centers for Disease Control, 1600 Clifton Rd NE, Bldg 1, Room 5127, Atlanta, GA 30333 (Dr Baron).


JAMA. 1983;250(21):2947-2951. doi:10.1001/jama.1983.03340210045023
Text Size: A A A
Published online
Article
References

In the period July 15, 1977, through March 30, 1982, there were at least 51 sudden, unexplained deaths in the United States among refugees from Southeast Asia. These deaths involved relatively young (median age, 33 years), previously healthy persons. All except one were male, and all died at night. Available data from studies among young adults in this country suggest that this specific phenomenon has an unusually high incidence among Laotian and Kampuchean refugees and, furthermore, has not previously been observed in the United States. Interviews with families of the decedents and a case-control study have failed to establish causal factors, but emotional stress cannot be ruled out as a contributing element. While reviews of the forensic investigations have confirmed the absence of important common pathological or toxicological findings, preliminary findings of special postmortem cardiac studies, now in progress, suggest that at least some of these deaths may be associated with developmentally abnormal conduction system pathways. Further studies are required to confirm this association, to define the apparently sleep-induced mechanism that triggers these deaths, and to explain the male preponderance in this disorder.

(JAMA 1983;250:2947-2951)

REFERENCES

1 +
Helpern M, Rabson SM:  Sudden and unexpected natural death: I. General considerations and statistics . NY State J Med 1945;;45:1197-1201.
2 +
Moritz AR, Zamcheck N:  Sudden and unexpected deaths of young soldiers: Diseases responsible for such deaths during World War II . Arch Pathol Lab Med 1946;;42:459-494.
3 +
Spain DM, Bradess VA, Mohr C:  Coronary atherosclerosis as a cause of unexpected and unexplained death: An autopsy study from 1949 to 1959 . JAMA 1960;;174:384-388.
4 +
Burch GE, DePasquale NP:  Sudden, unexpected, natural death . Am J Med Sci 1965;; 149:112-123.
5 +
Kuller L, Lilienfeld A, Fisher R:  An epidemiological study of sudden and unexpected deaths in adults . Medicine 1967;;46:341-361.
6 +
Luke JL, Helpern M:  Sudden unexpected death from natural causes in young adults: A review of 275 consecutive autopsied cases . Arch Pathol Lab Med 1968;;85:10-17.
7 +
Kuller LH:  Sudden death: Definition and epidemiologic considerations . Prog Cardiovasc lar Dis 1980;;23:1-12.
8 +
Weiss S:  Instantaneous physiologic death . N Engl J Med 1940;;223:793-797.
9 +
Lev M, Widran J, Erickson EE:  A method for the histopathologic study of the atrioventricular node, bundle, and branches . Arch Pathol Lab Med 1951;;52:73-83.
10 +
Lawley DN, Maxwell AE: Factor Analysis as a Statistical Method . Washington, DC, Butterworth Inc, 1971;.
11 +
Kilbourne EM, Choi K, Jones S, et al:  Risk factors for heatstroke: A case-control study . JAMA 1982;;247:3332-3336.
12 +
Chemical Warfare in Southeast Asia and Afghanistan , special report 98. 1982;, US Dept of State.
13 +
Ludwig J:  A review of lobular, portal, and periportal hepatitis . Hum Pathol Lab Med 1977;; 8:269-276.
14 +
Allen AC:  Eosinophilia of the spleen associated with sudden death . Arch Pathol Lab Med 1944;;37:20-23.
15 +
Kuller L, Lilienfeld A, Fisher R:  Sudden and unexpected deaths in young adults: An epidemiological study . JAMA 1966;;198:148-152.
16 +
Sta. Cruz JZ:  The pathology of 'Bangungut.' J Philippines Med Assoc 1951;;27:476-481.
17 +
Aponte GE:  The enigma of 'Bangungut.' Ann Intern Med 1960;;52:1258-1263.
18 +
Gotoh K:  A histopathological study on the conduction system of the so-called 'Pokkuri disease' (sudden unexpected cardiac death of unknown origin in Japan) . Jpn Circ J 1976;; 40:753-768.
19 +
Hinkle LE Jr, Thalar T:  Clinical classification of cardiac deaths . Circulation 1982;;65:457-464.
20 +
James TN:  Interpretation of pathologic anatomy associated with arrhythmias and conduction disturbances , in Hurst JW, Logue RB, Schlant RC, et al (eds): The Heart Arteries and Veins , ed 4. New York, McGraw-Hill Book Co, 1978;, pp 607-628.
21 +
Lown B, Temte JV, Reich P, et al:  Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management . N Engl J Med 1976;;294:623-629.
22 +
Parkes CM, Benjamin B, Fitzgerald RG:  Broken heart: A statistical study of increased mortality among widowers . Br Med J 1969;; 1:740-743.
23 +
Engel GL:  Sudden and rapid death during psychological stress: Folklore or folk wisdom? Ann Intern Med 1971;;74:771-782.
24 +
Green WA, Goldstein S, Moss AJ:  Psychosocial aspects of sudden death: A preliminary report . Arch Intern Med 1972;;129:725-731.
25 +
Rahe RH, Romo M, Bennett L, et al:  Recent life changes, myocardial infarction, and abrupt coronary death: Studies in Helsinki . Arch Intern Med 1974;;133:221-228.
26 +
Myers A, Dewar HA:  Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies . Br Heart J 1975;;37:1133-1143.
27 +
Jacobs S, Ostfeld A:  An epidemiological review of the mortality of bereavement . Psychosom Med 1977;;39:344-357.
28 +
Rissanen V, Romo M, Siltanen P:  Premonitory symptoms and stress factors preceding sudden death from ischemic heart disease . Acta Med Scand 1978;;204:389-396.
29 +
Helsing KJ, Moyses S, Comstock GW:  Factors associated with mortality after widowhood . Am J Public Health 1981;;71:802-809.
30 +
Reich CH, DeSilva RA, Lown B, et al:  Acute psychological disturbances preceding life-threatening ventricular arrhythmias . JAMA 1981;;246:233-235.
31 +
Lown B, Verrier RL:  Neural activity and ventricular fibrillation . N Engl J Med 1976;; 294:1165-1170.
32 +
Lown B, Verrier R, Corbalan R:  Psychologic stress threshold for repetitive ventricular response . Science 1973;;182:834-836.
33 +
Verrier RL, Thompson PL, Lown B:  Ventricular vulnerability during sympathetic stimulation: Role of heart rate and blood pressure . Cardiovasc Res 1974;;8:602-610.
34 +
Lown B:  Mental stress, arrhythmias and sudden death . Am J Med 1982;;72:177-180.
35 +
Shahaway ME:  Arrhythmias and the varieties of sleep . N Engl J Med 1970;;282:815.
36 +
Nevins DB:  First- and second-degree A-V heart block with rapid eye movement sleep . Ann Intern Med 1972;;76:981-983.
37 +
Lown B, Tykocinski M, Garfein A, et al:  Sleep and ventricular premature beats . Circulation 1973;;48:691-701.
38 +
Rosenblatt G, Hartman E, Zwilling GR:  Cardiac irritability during sleep and dreaming . J Psychosom Res 1973;;17:129-134.
39 +
Tilkian AG, Motta J, Guilleminault C:  Cardiac arrhythmias and sleep apnea , in Guilleminault C, Dement WC (eds): Sleep Apnea Syndromes . New York, Allen R. Liss Inc, 1978;, pp 197-210.
40 +
Guilleminault C, van den Hoed J, Mitler MM:  Clinical overview of the sleep anpea syndromes , in Guilleminault C, Dement WC (eds): Sleep Apnea Syndromes . New York, Allen R. Liss Inc, 1978;, pp 1-12.
41 +
Block AJ, Boysen TG, Wynne JW, et al:  Sleep apnea, hypopnea, and oxygen desaturation in normal subjects: A strong male predominance . N Engl J Med 1979;;300:513-517.
42 +
Rabson SM, Helpern M:  Sudden and unexpected natural death: II. Coronary artery sclerosis . Am Heart J 1947;;35:635-642.
43 +
Kuller L, Lilienfeld A, Fisher R:  Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease . Circulation 1966;;34:1056-1068.
44 +
Spain DM, Bradess VA:  Frequency of coronary thrombosis as related to duration of survival from onset of acute fatal episodes of myocardial ischemia . Circulation 1960;;22:816.
45 +
Friedman M, Manwaring JH, Rosenman RH, et al:  Instantaneous and sudden deaths: Clinical and pathological differentiation in coronary artery disease . JAMA 1973;;225:1319-1328.
46 +
Liberthson RR, Nagel EL, Hirschman JC, et al:  Prehospital ventricular defibrillation: Prognosis and follow-up course . N Engl J Med 1974;;291:317-321.
47 +
Baum RS, Alvarez H, Cobb LA:  Survival after resuscitation from out-of-hospital ventricular fibrillation . Circulation 1974;;50:1231-1235.
48 +
Cobb LA, Baum RS, Alvarez H, et al:  Resuscitation from out-of-hospital ventricular fibrillation: Four years of follow-up . Circulation 1975;;51/52( (suppl 3) ):23-28.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Helpern M, Rabson SM:  Sudden and unexpected natural death: I. General considerations and statistics . NY State J Med 1945;;45:1197-1201.
2 +
Moritz AR, Zamcheck N:  Sudden and unexpected deaths of young soldiers: Diseases responsible for such deaths during World War II . Arch Pathol Lab Med 1946;;42:459-494.
3 +
Spain DM, Bradess VA, Mohr C:  Coronary atherosclerosis as a cause of unexpected and unexplained death: An autopsy study from 1949 to 1959 . JAMA 1960;;174:384-388.
4 +
Burch GE, DePasquale NP:  Sudden, unexpected, natural death . Am J Med Sci 1965;; 149:112-123.
5 +
Kuller L, Lilienfeld A, Fisher R:  An epidemiological study of sudden and unexpected deaths in adults . Medicine 1967;;46:341-361.
6 +
Luke JL, Helpern M:  Sudden unexpected death from natural causes in young adults: A review of 275 consecutive autopsied cases . Arch Pathol Lab Med 1968;;85:10-17.
7 +
Kuller LH:  Sudden death: Definition and epidemiologic considerations . Prog Cardiovasc lar Dis 1980;;23:1-12.
8 +
Weiss S:  Instantaneous physiologic death . N Engl J Med 1940;;223:793-797.
9 +
Lev M, Widran J, Erickson EE:  A method for the histopathologic study of the atrioventricular node, bundle, and branches . Arch Pathol Lab Med 1951;;52:73-83.
10 +
Lawley DN, Maxwell AE: Factor Analysis as a Statistical Method . Washington, DC, Butterworth Inc, 1971;.
11 +
Kilbourne EM, Choi K, Jones S, et al:  Risk factors for heatstroke: A case-control study . JAMA 1982;;247:3332-3336.
12 +
Chemical Warfare in Southeast Asia and Afghanistan , special report 98. 1982;, US Dept of State.
13 +
Ludwig J:  A review of lobular, portal, and periportal hepatitis . Hum Pathol Lab Med 1977;; 8:269-276.
14 +
Allen AC:  Eosinophilia of the spleen associated with sudden death . Arch Pathol Lab Med 1944;;37:20-23.
15 +
Kuller L, Lilienfeld A, Fisher R:  Sudden and unexpected deaths in young adults: An epidemiological study . JAMA 1966;;198:148-152.
16 +
Sta. Cruz JZ:  The pathology of 'Bangungut.' J Philippines Med Assoc 1951;;27:476-481.
17 +
Aponte GE:  The enigma of 'Bangungut.' Ann Intern Med 1960;;52:1258-1263.
18 +
Gotoh K:  A histopathological study on the conduction system of the so-called 'Pokkuri disease' (sudden unexpected cardiac death of unknown origin in Japan) . Jpn Circ J 1976;; 40:753-768.
19 +
Hinkle LE Jr, Thalar T:  Clinical classification of cardiac deaths . Circulation 1982;;65:457-464.
20 +
James TN:  Interpretation of pathologic anatomy associated with arrhythmias and conduction disturbances , in Hurst JW, Logue RB, Schlant RC, et al (eds): The Heart Arteries and Veins , ed 4. New York, McGraw-Hill Book Co, 1978;, pp 607-628.
21 +
Lown B, Temte JV, Reich P, et al:  Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management . N Engl J Med 1976;;294:623-629.
22 +
Parkes CM, Benjamin B, Fitzgerald RG:  Broken heart: A statistical study of increased mortality among widowers . Br Med J 1969;; 1:740-743.
23 +
Engel GL:  Sudden and rapid death during psychological stress: Folklore or folk wisdom? Ann Intern Med 1971;;74:771-782.
24 +
Green WA, Goldstein S, Moss AJ:  Psychosocial aspects of sudden death: A preliminary report . Arch Intern Med 1972;;129:725-731.
25 +
Rahe RH, Romo M, Bennett L, et al:  Recent life changes, myocardial infarction, and abrupt coronary death: Studies in Helsinki . Arch Intern Med 1974;;133:221-228.
26 +
Myers A, Dewar HA:  Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies . Br Heart J 1975;;37:1133-1143.
27 +
Jacobs S, Ostfeld A:  An epidemiological review of the mortality of bereavement . Psychosom Med 1977;;39:344-357.
28 +
Rissanen V, Romo M, Siltanen P:  Premonitory symptoms and stress factors preceding sudden death from ischemic heart disease . Acta Med Scand 1978;;204:389-396.
29 +
Helsing KJ, Moyses S, Comstock GW:  Factors associated with mortality after widowhood . Am J Public Health 1981;;71:802-809.
30 +
Reich CH, DeSilva RA, Lown B, et al:  Acute psychological disturbances preceding life-threatening ventricular arrhythmias . JAMA 1981;;246:233-235.
31 +
Lown B, Verrier RL:  Neural activity and ventricular fibrillation . N Engl J Med 1976;; 294:1165-1170.
32 +
Lown B, Verrier R, Corbalan R:  Psychologic stress threshold for repetitive ventricular response . Science 1973;;182:834-836.
33 +
Verrier RL, Thompson PL, Lown B:  Ventricular vulnerability during sympathetic stimulation: Role of heart rate and blood pressure . Cardiovasc Res 1974;;8:602-610.
34 +
Lown B:  Mental stress, arrhythmias and sudden death . Am J Med 1982;;72:177-180.
35 +
Shahaway ME:  Arrhythmias and the varieties of sleep . N Engl J Med 1970;;282:815.
36 +
Nevins DB:  First- and second-degree A-V heart block with rapid eye movement sleep . Ann Intern Med 1972;;76:981-983.
37 +
Lown B, Tykocinski M, Garfein A, et al:  Sleep and ventricular premature beats . Circulation 1973;;48:691-701.
38 +
Rosenblatt G, Hartman E, Zwilling GR:  Cardiac irritability during sleep and dreaming . J Psychosom Res 1973;;17:129-134.
39 +
Tilkian AG, Motta J, Guilleminault C:  Cardiac arrhythmias and sleep apnea , in Guilleminault C, Dement WC (eds): Sleep Apnea Syndromes . New York, Allen R. Liss Inc, 1978;, pp 197-210.
40 +
Guilleminault C, van den Hoed J, Mitler MM:  Clinical overview of the sleep anpea syndromes , in Guilleminault C, Dement WC (eds): Sleep Apnea Syndromes . New York, Allen R. Liss Inc, 1978;, pp 1-12.
41 +
Block AJ, Boysen TG, Wynne JW, et al:  Sleep apnea, hypopnea, and oxygen desaturation in normal subjects: A strong male predominance . N Engl J Med 1979;;300:513-517.
42 +
Rabson SM, Helpern M:  Sudden and unexpected natural death: II. Coronary artery sclerosis . Am Heart J 1947;;35:635-642.
43 +
Kuller L, Lilienfeld A, Fisher R:  Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease . Circulation 1966;;34:1056-1068.
44 +
Spain DM, Bradess VA:  Frequency of coronary thrombosis as related to duration of survival from onset of acute fatal episodes of myocardial ischemia . Circulation 1960;;22:816.
45 +
Friedman M, Manwaring JH, Rosenman RH, et al:  Instantaneous and sudden deaths: Clinical and pathological differentiation in coronary artery disease . JAMA 1973;;225:1319-1328.
46 +
Liberthson RR, Nagel EL, Hirschman JC, et al:  Prehospital ventricular defibrillation: Prognosis and follow-up course . N Engl J Med 1974;;291:317-321.
47 +
Baum RS, Alvarez H, Cobb LA:  Survival after resuscitation from out-of-hospital ventricular fibrillation . Circulation 1974;;50:1231-1235.
48 +
Cobb LA, Baum RS, Alvarez H, et al:  Resuscitation from out-of-hospital ventricular fibrillation: Four years of follow-up . Circulation 1975;;51/52( (suppl 3) ):23-28.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems