Sudden unexpected nocturnal death syndrome in the Mariana Islands

Sudden unexpected nocturnal death syndrome (SUNDS) is a distinct clinical entity in previously healthy, young, Southeast Asian males. It is well known in the Philippines and more recently recognized in the U.S. by nonspecific autopsy findings, with no evidence of underlying disease and absence of toxic drug or alcohol levels. In 1973-89, 14 cases of apparent SUNDS came to coroner's autopsy in the Commonwealth of the Northern Marianas (CNMI) and Guam. All 14 cases, with the exception of one Yapese, were previously healthy, male Filipinos, aged 23 to 55, who were either found dead in bed, or described by their colleagues as having nocturnal seizure activity consisting of gurgling, frothing, and tongue biting immediately prior to death. Autopsy findings showed no anatomic findings to account for death. Comprehensive serum and urine drug analyses were negative. All decedents showed absence of significant atherosclerosis or grossly detectable structural cardiac anomaly, while four showed cardiomegaly. Migrants from Southeast Asia carry with them a pre-disposition to this syndrome, which appears to decline with longer residence in the new country. The mechanism of death in SUNDS is believed to be ventricular fibrillation, possibly precipitated by sudden sympathetic discharge. Studies suggest at least some deaths may be associated with an abnormal cardiac conduction system. Acute pancreatitis has been a finding in some series, but not our cases. Why the condition is virtually limited to males and seemingly sleep-triggered, has not been adequately explained. Stress and depression are believed to be predisposing factors.     

Book reviews

E. Glyn Lewis, Multilingualistn in the Soviet Union: aspects of language policy and its implementation. The Hague and Paris: Mouton, 1971. xx+332pp. Dfl 62.

L. G. Churchward, The Soviet Intelligentsia. An essay on the social structure and roles of Soviet intellectuals during the 196os. London and Boston: Routledge & Kegan Paul, 1973. xiii + 204 pp. £3.25.

Galia Golan, Reform Rule in Czechoslovakia. The Dubcek Era 1968–1969. Cambridge: at the University Press, 1973. Vii + 327 pp. £5.80. $18.50.

Otto Ul?, The Judge in a Communist State. A View from Within. Athens, Ohio: Ohio UP, 1972. xiv + 307 pp. $8.75.

Robert M. Slusser, The Berlin Crisis of 1961: Soviet‐American relations and the struggle for power in the Kremlin, June‐November 1961. Baltimore and London: The Johns Hopkins UP, 1973. xvi + 509 pp. $17.50. £7.90.

Edward Taborsky, Communist Penetration of the Third World. New York: Robert Speller & Sons, 1973. iii + 500 pp. $12.50.

Philip R. Pryde, Conservation in the Soviet Union. London: Cambridge UP, 1972. xv + 301 pp. £5.00.

Marshall I. Goldman, The Spoils of Progress: Environmental Pollution in the Soviet Union. Cambridge, Mass, and London: The M.I.T. Press, 1972. xi + 372 pp. $7.95. £3.60.

Robert H. McNeal, Bride of the Revolution. Krupskaya and Lenin. London: Victor Gollancz, 1973. 326 pp. £3.60.

George Katkov et al. (eds.), Russia Enters the Twentieth Century 1894–1917. London: Methuen, 1973. 352 pp. £1.50 (paperback).

Paul Craig Roberts and M. Stephenson, Marx's Theory of Exchange, Alienation and Crisis. Stanford, Calif.: Hoover Institution Press, 1973. 127 pp. $5.50.

W. H. Parker, The Russians: How They Live and Work. Newton Abbot: David & Charles, 1973. 179 pp. £2.50.

Wright Miller, Who are the Russians? A History of the Russian People. London: Faber & Faber, 1973. 240 pp. £3.95.