EPIDEMIOLOGY OF LONG QT AND ASIAN SUDDEN DEATH IN SLEEP

睡眠中原因不明的猝死是导致死亡的主要原因。 在几个亚洲人口中的年轻男性。直接原因是 在没有已知疾病的情况下，室颤。一个坚强的人 环境成分可以从肥皂泡的区域性质中推断出来 在文化和基因上截然不同的群体中， 东南亚难民移民后肥皂率的下降 去美国。35岁男性患肥皂水的风险急剧上升至峰值 年龄，然后随着年龄的增长而下降。 在我们对东南亚难民男性在泰国的初步研究中 已知的肥胖症风险我们记录了心率延长的高流行率 校正的QT间期(QTC)、硫胺素缺乏、低钾血症和 不良的硫胺素状态之间的正相关性，通过 红细胞转酮醇酶活性(ETK)和QT_c。这些有限的研究 我们无法准确地量化QTC和 硫胺素状态，缺乏足够的力量来检查这种关系 在QTC和低钾血症之间，不包括其他电解质，并且确实 没有考虑到不同性别和年龄的肥皂水风险的显著差异。 我们建议进行一项横断面流行病学研究，以确定 在已知最高的人群中，300名男性和300名女性的QTC 肥皂泡的风险：东南亚难民在泰国。在14个月的时间里， 知情同意将从选定的对象那里获得 按年龄分层随机抽样的难民，计划接受常规医疗 放映。血样，12导联和24小时心电图，以及面谈数据 将收集以检验以下假设：(1)平均QTc值为 男性大于女性；(2)30-39岁男性平均QTc值较大 比年轻或年长的男性多几岁；不会有类似的关系 在女性中，(3)QTC与较差的硫胺素状态呈正相关， 以红细胞转酮醇酶活性衡量，(4-6)QTc值为负值 与血清钾、镁和总钙水平相关， (7)QT间期与自主神经控制异常有关。 心率变异性的功率谱分析表明，心脏。 次要目标包括研究硫胺素状态和 电解质对QT间期延长、QT间期变化的动态分析 根据24小时心电图中的心率水平，并收集血液样本 后来的基因研究。 这项研究可能会导致公共卫生措施，以减轻 东南亚人群中的睡眠猝死。它更广泛的科学 重要的是对新的环境模式的潜在描述 诱发QT间期延长、自主神经功能障碍和猝发风险 在睡梦中死去。

Sudden and unexplained death in sleep (SUDS) is a leading cause of death of young men in several Asian populations. The immediate cause is ventricular fibrillation in the absence of known disease. A strong environmental component may be inferred from the regional nature of SUDS in groups that are culturally and genetically distinct and the rapid decline in rates of SUDS after migration of Southeast (SE) Asian refugees to the US. Risk of SUDS rises sharply to a peak among men aged 35 years of age, then declines with increasing age. In our pilot studies of SE Asian refugee men in Thailand with the highest known risk of SUDS we documented high-prevalences of prolonged heart rate corrected QT interval (QTc), thiamine deficiency, hypokalemia, and a positive association between poor thiamine status, measured by erythrocyte transketolase activity (ETK), and QTc. These limited studies were unable to precisely quantify the relationship between QTc and thiamine status, lacked sufficient power to examine the relationship between QTc and hypokalemia, did not include other electrolytes, and did not address the striking differences in risk of SUDS by sex and age. We propose a cross-sectional epidemiologic study of the determinants of QTc among 300 men and 300 woman in the population with the highest known risk of SUDS: SE Asian refugees in Thailand. During a 14-month period, informed consent will be obtained from subjects selected in an age-stratified random sample of refugees scheduled for routine medical screening. Blood samples, 12-lead and 24-hour ECGs, and interview data will be collected to test the following hypotheses: (1) mean QTc is greater in men than women, (2) mean QTc is greater in men aged 30-39 years than in men younger or older; no similar relationship is expected among women, (3) QTc is positively correlated with poor thiamine status, measured by erythrocyte transketolase activity, (4-6) QTc is negatively correlated with serum levels of potassium, magnesium, and total calcium, and (7) QTc is associated with abnormalities of autonomic control of the heart, as indicated by power spectral analysis of heart rate variability. Secondary aims include study of interactions of thiamine status and electrolytes in the prolongation of QTc, dynamic analysis of QT variation by heart rate level in 24-hr ECGs, and collection of blood specimens for later genetic studies. This study may lead to public health measures that reduce the burden of sudden death in sleep in SE Asian populations. Its broader scientific importance is the potential description of new models of environmentally induced prolonged QT interval, autonomic dysfunction, and risk of sudden death in sleep.