Nov 25, 2010

Can Sleep Deprivation Lead to Sudden Death?

This post is dedicated to Paulo Layug who joined his creator on No.16, 2010.
It started like an ordinary day. When I came home after work I opened my inbox. I was surprised to see an e-mail without a subject from my friend Eva. I almost deleted it thinking it was a spam. But I was aghast upon reading the message. I could not believe what was written on it. "Paulo, my godson passed away!". He was just a young lad. He was about to graduate from college. How could have that happened? What are the probable reasons? It could only be accidents or acute illnesses like dengue, which is endemic in the Philippines could take away a young man's life so suddenly.

When we came to the wake we learned what really transpired on that fateful day. Paulo was in his boarding house in Manila. After a sleepless night spent playing his favorite game of Dota he complained of not being well. (It was worthy to note that as a computer-game fanatic he was not mindful that  having little sleep most of the time.) In the afternon while laying on a couch he was seen by his cousins displaying jerky movements. They immediately came to his aid, but  he abruptly stopped breathing. His pulse could not be palpated. His cousin who was Red Cross-trained tried resuscitating him. He was revived, though temporarily temporarily. He expired once again on his way to the hospital, a mere 15 minute drive from where they were living. Futher resuscitation efforts at the emergency room were to avail. He met his demise at a tender age of 21.

Paulo's mother Melinda, a long-time friend of mine back in our college days in Odessa, noted that several men in their family, including her father and elder brother died under the same condition, "sudden death after a sleepless night." We were bewildered. Is there any relationship between the two:
sleep deprivation and sudden death? Could sleep deprivation be a cause of sudden death? As a chronic insomniac myself , this really caught my attention. I badly needed an answer to this question. Hence, as soon as I got home I rummaged through the pages of the net. The search engines have made my task easy. I was surprised to find a multitude of scientific studies tackling the subject of sleep deprivation in conjunction with sudden death. Here are some of these:

In 1997 Deccan Chronicle's correspondent wrote about the risks techies are facing being chronically sleep-deprived. Executives and corporate employees live in a very competitive work, hence work is their top priority. He mentioned the sudden death of 42 y.o. Ranjan Das, the youngest CEO oan MNC in India. Workaholic Das was getting very little sleep.

In an article published by Soon Young Sun, et al a case of a 40 y.o. woman was mentioned presenting with squeezing substernal pain following a 72h sleep deprivation. Level of CK-MB and Troponin-T were elevated. Coronary angiography demonstrated a longitudinal dissection of the middle portion in the diagonal artery. These findings suggest Myocardial Infarction, associated with spontaneous coronary dissection.

At Wiley Online Library I came across an article by Orhan Ozer and others. They wrote about their electrocardiographic findings in relation to this subject.  They have noted that QT dispersion, which is known to be a predictor of ventricular arrhytmia and sudden death  was increased in healthy individuals with acute sleep deprivation.

Tai Sekine and others studied the impact of sleep deprivation on the coronary circulation. They used Coronary Flow Velocity Reserve (CFVR) as a parameter and measured it with transthoracic Doppler echocardiography. The results showed that CFVR was lower after slep deprivation than after normal sleep.
This finding suggests that sleep deprivation might serve as a trigger for cardiovascular risk.

In a study entitled "Erythrocyte Magnesium and Prostaglandin Dynamics in Chronic Sleep Deprivation" it was shown that mean erythrocyte Mg level was significantly lower in the state of chronic sleep deprivation than in control state and temporary sleep deprivation, while thromboxane B2 was significantly higher in the state of chronic sleep deprivation than in control and in temporary sleep deprivation. These findings support the hypothesis that decrease erythrocyte Mg content and increase in thromboxane B2 could predispose to cardiac events by inducing coronary arterial spasm or coronary arterial thrombus formation. 

Hans Meier-Ewert and his colleagues conducted an experiment in 2004 on the effect of sleep loss on C-reactive protein (CRP), an inflammatory marker of cardiovascular risk. The results showed that CRP concentration increased during both total and partial sleep deprivation, but remained stable in the controlled condition. It was also noted in this study that sleep deprivation in healthy individuals has been found to lead to increased peripheral circulation of leukocytes and interleukin (IL-6).

One hypothesis for the link between cardiovascular risk and elevated CRP is that vascular shear stress exacerbated blood pressure (BP) leads to inflammation in the vascular wall. A single episode of 50% reduced sleep resulted to an increase in systolic and diastolic BP and heart rate. All these findings support the hypothesis that inflammatory processes are activated by inadequate sleep.

Based on the above-mentioned studies we can therefore conclude that sleep deprivation could lead to sudden death by triggering several mechanisms in our system which pave the way to cardiovascular events.

Now we should have realized the importance sleep plays in our daily lives. It is not something that should be left in the back door.So for all the insomniacs, call-center agents, graveyard-shift workers and for all those who are not having enough sleep for various reasons it is for us then to take the necessary precaution to avoid this kind of incidents from happening. The solution is simple, you don't have to buy it: just change your habit, give yourself an adequate amount of sleep. It is not yet late. As an email headline said: Sleep, else you might sleep forever.


1. Techies Wake Up to the Risks of Sleep Deprivation.Deccan Chronicle 2009    Nov.18

2. Soon Young Suh, Jin Won Kim, et al. Spontaneous Coronary Dissection,Associated with Sleep Deprivation Presenting with Acute Myocardial Infarction. International Journal of Cardiology 2007;115-2:e78-79

3. Orhan Ozer, MD,Burcu Ozbala,MD, et al. Acute Sleep Deprivation Assocaited with Increased QT Dispersion in Helathy Young Adults. Pacing and Clinical Electrophysiology 2008;31-8:979-984

4. Tao Sekine, Masao Daimon, et al. The Imapact of Sleep Deprivation on hte Coronary Circulation. International Journal of Cardiology 2010;144-2:266-267

5. Kazuhiko Tanabe MD, Naohiko Osaka MD, et al. Erythrocyte Magnesium and Prostaglandin Dynamics in Chronic Sleep Deprivation. Clinical Cardiology 1997;20:265-268

6. Hans K. Meier-Ewert,MD, Paul M.Ridker,MD, et al. Effects of Sleep Loss on C-reactive-protein, an Inflammatory Marker of Cardiovascular Risk. Journal of the American College of Cardiology 2004.;43:678-683