When young adults, usually males, die in their sleep, the death is sometimes attributed to bangungot (nightmare).
Usual aggravating factors believed to trigger it, in the layman’s mind, are heavy food intake and excessive drinking of alcohol just before sleeping.
Specialists in heartbeat irregularities (arrhythmias) have reported cases of what is called the Brugada Syndrome, a familial or genetic disease first reported by the Spanish family of cardiologists Pedro, Josep and Ramon Brugada in 1992 as a cause of sudden unexplained death syndrome (SUDS) among young males.
These men usually have typical electrocardiogram (ECG) findings, but since these are young adults, these findings are passed off as nonspecific and of no clinical significance by unsuspecting physicians.
Based on available local data, it is estimated that there are around 180,000 of the youth population in the Philippines who might have the Brugada Syndrome, and who are at risk of sudden death. Among them could be your loved ones.
These young individuals, with no previous symptoms, are not diagnosed early enough before they suffer sudden cardiac arrest. Some could have fainting or near-fainting spells, which are dismissed and believed caused by insignificant causes—not by a potentially life-threatening heart rhythm problem.
The giddiness or fainting spells are merely due to the heat or physical exhaustion— that’s the notion, thus, no medical consultation is done.
In fact, a serious irregularity in the heartbeat occurs, causing the heart to actually stop or have ineffective heartbeat for several seconds.
Since no blood or insufficient blood is pumped to the brain, the individual loses consciousness. But after several seconds, the normal heartbeat resumes and the individual regains consciousness with no residual symptom. Thus, the notion that it couldn’t be serious—until the next
attack, which could be fatal.
When the heart goes into a standstill for some time, it could be difficult to reinitiate a normal heart rhythm. Unless resuscitated, the young individual dies.
It is usually the men who are affected, although women are not totally exempted.
Local experts like Dr. Giselle Gervacio-Domingo published several papers on this topic in medical journals. There’s good reason to believe that many young Filipino men, who died in their sleep, were victims of Brugada Syndrome.
In local medical literature, it is called Bangungot Syndrome. The term was coined because the victims were said to be moaning and groaning in their sleep. Bangungot comes from the Tagalog root words bangon (to rise) and ungol (to moan).
“Sudden night deaths” among young males have been reported in local literature since 1917, and were attributed to the nightmarish dream just preceding death.
Local folklore and myths have embellished the syndrome—like a fairy taking fancy on a young man and wanting him to join her in her kingdom.
Then there’s the layman’s perception that the syndrome is linked to heavy carbohydrate intake, fatty meals and high alcohol consumption. This has scientific basis.
The identification of young males—aged 25 to 44, presumably healthy, without any known cardiac illness—as at-risk individuals is consistent with international scientific reports on the Brugada Syndrome.
In Thailand, it is called lai tai. Thai folklore attributes death to the “widow ghost” who scours the night for healthy young men. The
prevalence is 26-40 per 100,000 of the population.
In Japan, it’s called pokkuri—a peaceful death in sleep. It has a similar prevalence rate.
The syndrome was first identified by the Brugada brothers among Southeast Asian males, who seemed to be predisposed to it.
Similar cases are found in Pacific Rim countries and Polynesian populations where Southeast Asians have migrated.
‘Holiday Heart Syndrome’
In 1998, foreign epidemiologists Munger RG and Booton EA published a report in an international journal, titled “Bangungut in Manila: Sudden and unexplained death in sleep of adult Filipinos,” based on autopsy records from 1948 to 1982.
They observed that the deaths were seasonal, peaking in December-January. This may somehow be related to what was later described as the “Holiday Heart Syndrome,” which is attributed to excessive alcohol intake during the holiday season.
In Munger’s and Booton’s report, the victims were predominantly males, aged 25-44. The deaths generally occurred past midnight, at around 3-4 a.m.
A later report filed by our local experts led by Dr. Gervacio-Domingo showed a frequency of 43 per 100,000 of the population per year, still predominantly males. The report was derived from the National Nutrition Health Survey of 2003, which included the Bangungot Syndrome in its survey of common medical problems in the Philippines.
We have quite a number of our young population who have the Brugada pattern on ECG and are potential victims of this deadly syndrome.
The problem is that they remain undiagnosed because they usually have no symptoms and are thought to be healthy because they’re young.
But if they have fainting or near-fainting spells, they must consult a specialist to rule out this problem.
Theoretically, an ECG can diagnose those with the Brugada pattern. But some experts believe it is not feasible for the general population to have an ECG.
However, those with a history of sudden death in the family, especially deaths occurring in sleep, and those that involved males, should be screened.
If one also has a history of fainting (syncope), it’s best to make sure that it’s not related to a heart arrhythmia (irregular heartbeat), which can lead to sudden cardiac arrest.
If an individual is diagnosed with Brugada Syndrome and further tests show increased risk of sudden cardiac arrest, preventive measures must be taken.
Some medicines like the good old quinidine have been shown to be effective in
preventing life-threatening arrhythmias.
For those who can afford it, however, an implantable cardiac defibrillator (ICD), similar to an artificial pacemaker battery, could be surgically implanted just beneath the skin layer on the chest. It’s hooked to the heart and gives it a mild “shock” (defibrillate) whenever the heart goes into a life-threatening heartbeat.
Every time it does, the young individual with the ICD knows that he could have gone into cardiac arrest if he did not have the ICD.
One of our young consultants in the hospital has it and when he feels his ICD giving his heart a mild electrical shock, he pauses and whispers a short prayer thanking God again for saving him a hundredth time from death.