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Sudden unexpected nocturnal death syndrome (SUNDS) occurs predominantly in Southeast Asia, and the young healthy victims are struck by unexplained deaths during nocturnal sleep. The predilection time implies that the balance of the autonomic nervous system is associated with arrhythmogenesis. Mongkonsiri, et al. reported that healthy subjects with a family history of SUNDS showed blunted responsiveness to cold pressor testing and steady exercise during the nighttime, indicative of decreased sympathetic and increased parasympathetic nerve activity. Regarding the autonomic imbalance in patients with Brugada syndrome, a disease relevant to SUNDS, inconsistent results have been reported. Some papers have revealed that adrenergic dysfunction was observed in diseased groups, while others reported no differences in heart rate variability. However, Brugada syndrome and SUNDS are regarded as different diseases in that the latter is more likely a multifactorial disorder caused by both intrinsic pathogenic genes and external environmental factors. Various factors implicated with susceptibility to SUNDS, including diet, lifestyle, and work intensity could contribute to the tuning of the autonomic nervous system rather than the direct effects of genetics, as previously reported.

Maladaptive Alterations of Autonomic Nerve System in Cardiovascular Disorders