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18 October 2023
Writer Nitikarn Papronpat
Medical research conducted at Chulalongkorn University showed that a considerable number of Thais carry the Brugara Syndrome gene. People with a family history of sudden death are recommended to observe for any risk symptoms and seek medical professionals for early diagnosis. Early treatment and prevention could reduce fatality rate.
While many people try to get a healthy deep sleep, sleep could be a silent threat that leads to premature death. Numbers of Thais who have Brugada syndrome or passed away while asleep have made local and international news. This includes Southeast Asians, particularly the Hmong ethnic group who migrated to the US and passed away while asleep, Thai construction workers who passed away while working in Singapore, and the premature death of a famous teenage male actor.
“Brugada Syndrome is most common in the male population of Southeast Asia. In Thailand, the most common cases are found in the Northeast and the North among fit and healthy young men who would sleep and talk in their sleep before passing away,” said Professor Apichai Khongphatthanayothin, M.D., Faculty of Medicine, Chulalongkorn University, on the importance of Brugada syndrome research. Brugada syndrome, an abnormality in heart rhythm, is one of the major causes of Brugada syndrome. There is currently ongoing research on Brugada syndrome in the Thai population by the Thai Brugada Syndrome (BrS) Research Group. The research is led by Chulalongkorn University in collaboration with 15 other institutions in Thailand*.
*The 15 participating institutions are as follows:
The Brugada syndrome research aims to identify the “Genetic predisposition” cause of Brugada syndrome, improve prevention and treatment guidelines, and identify factors affecting variation in disease severity in different patients.
Brugada syndrome is often used to describe people who pass away during sleep and are called Sudden Unexplained Nocturnal Death Syndrome (SUNDS) in Western countries. Brugada syndrome also has different names in different parts of the world, such as “Lai Tai” in Thailand, “Pokkuri Death Syndrome” (PDS) (ポックリ死亡症候群) in Japan, or “Bangungut” in the Philippines
Patients with Brugada syndrome can express different symptoms with some being asymptomatic making individuals unaware of having the disease. The current diagnostic guideline includes the use of an Electrocardiogram (ECG) to identify the presence of marker(s) for cardiac arrhythmia, which was demonstrated to increase the risk of the syndrome. The development of severe cardiac arrhythmia could potentially lead to death.
“Brugada symptoms often manifest at night. Symptoms include Agonal breathing, which occurs when patients gasping for air after severe cardiac arrhythmias due to the absence of blood supply to the brain. Patients could experience restlessness or tenseness in their sleep like they are about to faint. While the next day patients could feel hazy when they wake up or some may faint, mostly when they are not performing any heavy activities. The worst-case scenario is passing away in their sleep.”
Sudden Unexplained Nocturnal Death Syndrome (SUNDS) is common among Asians, especially Southeast Asians. The incidence rate in Thailand and Southeast Asia is estimated to be 1 in 1,000, which is higher than the incidence rate of 1 in 2,000 found in other countries.
“We still don’t know the exact cause of such high incident rate in Thais, but “Genetic predisposition“ has been thought to play an important role in the disease prevalence. Our team is trying to figure out which genetic factors cause such high incidence found in Thailand when compared to other regions of the world or why this disease is more prevalent in Southeast Asians than other races.”
Even in Thailand, Sudden Unexplained Nocturnal Death Syndrome (SUNDS) is more common in the North and the Northeast regions and is not often found in the South.
“Some people in the Northeast have low potassium levels. Would this play a part in inducing the condition of SUNDS death? Or is it diet? Because in the North and Northeast, people tend to eat foods that are higher in carbohydrates than in other regions, can this also be the cause? This is still being researched.”
At present, it can be concluded that Brugada syndrome can be caused by either genetics or environmental factors.
Other risk factors for arrhythmia include male sex as men are more likely to develop the disease than women (while reasons are under research), or excessive consumption of carbohydrates like rice, flour, sugar, and alcohol.
While Thai men are at risk of having this syndrome, it is not practical to screen all Thai men as ECG must be performed on an individual basis. Prof. Dr. Apichai recommends that only those with “warning” signs should consult the doctor for an ECG test. These “warning” signs include:
To date, there is no cure for Brugada syndrome. Doctors will provide palliative care to an individual who is diagnosed with the disease including:
Brugada syndrome is not always fatal if you know how to prevent it and receive timely treatment.
“Most people who come to the hospital are patients with certain symptoms, but those who are asymptomatic do not come to the hospital,” Prof. Dr. Apichai said.
“Patients who come for an ECG test and are found to have Brugada Syndrome are unlikely to die, especially when received proper care instructions, so early treatment with medical experts is important.”
Once diagnosed, the medical team will advise the patient about the factors that will trigger the arrhythmia. This includes:
Prof. Dr. Apichai ended with a recommendation for healthy habits, “Eating a high-carb diet doesn’t cause Brugada syndrome, but if you are diagnosed with Brugada syndrome, eating a high sugar, high-carb diet, heavy meals, and drinking alcohol, especially before sleep, can lead to cardiac arrhythmia and possibly death. However, if a normal person maintains a high-carbohydrate diet, it can lead to obesity, heart disease, and other chronic non-communicable diseases (NCDs).”
Those interested in undergoing a diagnosis of “Brugada Syndrome” and receiving counseling for its treatment can contact the Center of Excellence in Arrhythmia Research, Faculty of Medicine, Chulalongkorn University, brugadaproject@gmail.com.
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The sense of kinship and warmth found in the Chula community is priceless and a treasure worth keeping. Prof. Dr. Pornanong Aramwit Faculty of Pharmaceutical Sciences, Chulalongkorn University
The sense of kinship and warmth found in the Chula community is priceless and a treasure worth keeping.
Prof. Dr. Pornanong Aramwit Faculty of Pharmaceutical Sciences, Chulalongkorn University
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