Why do people die in their sleep? Sudden death due to cardiac causes: from acute coronary insufficiency and others

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Why do people die in their sleep?

There is no secret in this. If people sleep for about 8 hours every day and die from “ natural causes", then in 1 out of 3 cases they die in their sleep. However, in addition to this, there are strange deaths, directly related to sleep, they still put medical science at a dead end and defy scientific explanation. This phenomenon is called sudden and unexplained death syndrome (SUDS). SIDS is observed among adults and especially often among Asian men. No one knows why this phenomenon is most common in men and why Asians are so susceptible to it. The U.S. Centers for Disease Control in Atlanta named SIDS as the leading cause of death among young Southeast Asian men who fled to the United States in the early 1980s. SVDS has even been called sudden adult death syndrome, by analogy with sudden infant death, which is the leading cause of death in children under 1 year of age in Australia.

The first description of SVNS in medical literature appears in 1917 in the Philippines, where it was called bangungut. In 1959, a report from Japan named the syndrome pokkuri. He was written about in Laos, Vietnam, Singapore and throughout Asia. The syndrome is known by different names, but it is still the same strange one, unexplained phenomenon. Immediately before his death, all of his victims are in good health. Their tragic sudden death comes as a real shock to their loved ones. The family often remains in poverty, since it was the deceased man who brought money into the house. Witnesses say that at first the victim sleeps normally, and then, out of the blue, begins to moan, wheeze, snore strangely, suffocate, and ultimately dies. Doctors call these agonal signs. Most victims of the syndrome die from ventricular arrhythmia, sometimes after several minutes of agony. The ventricles are small cavities at the bottom of the heart, and arrhythmia is a local involuntary contraction of the muscle. Sometimes loved ones tried to wake up the suffering person. However, even if this was possible, it turned out to be useless - the person still died. When they did the autopsy, they didn't find life-threatening pathologies, signs of accidental poisoning, allergies or murder.

In 1992, seven scientists wrote about their two-year study of SVNS in northeastern Thailand. They pointed out that the typical model of SVNS is the following: after agonal signs, a person dies within 24 hours; he is usually between 20 and 49 years old, he has no "stories serious illnesses, during the previous year there was good health, and during the day before death - normal performance" 16 . Scientists add that “in 63% of cases, death occurred in front of witnesses, and the remaining victims were found in sleeping and resting positions. In cases where people were present, 94% of deaths were observed within an hour of the onset of the agony. All the people who died from SVNS were men...” U dead people was normal weight. Smoking, drugs, alcohol, and others possible factors there was no risk to their lives.

Interestingly, the probability of SIDS among family members of the deceased was 40.3%. 18.6% of victims had brothers who also died suddenly, but none had sisters who died in this manner. SVNS gives the impression of being a seasonal phenomenon.

At least in Thailand to the greatest extent people are susceptible to it during March - May, and rarely die in September - November. Researchers note that in Thailand, SVNS is now becoming "a potentially serious public health problem." This syndrome kills approximately 3,000 men a year between the ages of 20 and 49 and is considered one of the leading causes of death in this world. age group along with accidents, poisonings, murders and heart attacks.

It is not surprising that in the absence scientific explanation of this syndrome, superstitions are widespread in towns and villages. Researchers say that people in rural areas of northeastern Thailand call SVNS laithai (“death in sleep”). The local explanation for laitai is that the “widow ghost” seeks the souls of young men. Having found the soul, she waits for the man to fall asleep and then kidnaps it, followed by sudden death. Scientists indicate that “Fear of laitai and the ‘ghost widow’ is widespread in northeastern Thailand, with rituals emerging that include disguising sleeping men with women’s cosmetics, nail polish and bed clothes.”

One hypothesis regarding sudden death syndrome is that a combination of physical and mental stressors may somehow trigger SIDS. As an example, one 1978 study cited psychological factors as triggers for associated heart disease. However, other scientists consider this point of view very controversial 17.

“Ghost Widow” or something else, but SVNS remains a secret for now 18.

It is estimated that over the past three and a half millennia there have been only 230 peaceful years in the civilized world.

If the same mortality rate were maintained today as it was in 1900, more than half the people now inhabiting the planet would be dead.

Famous last words French President Charles de Gaulle's words were: "It hurts."

In World War II, killing each enemy soldier cost the Triple Alliance $300,000.

Under British law passed in 1845, attempting suicide is a crime punishable by death.

Nowadays, only one person out of 2 billion lives to be 116 years or more.

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Sudden death due to cardiac causes: from acute coronary insufficiency and others

Sudden cardiac death (SCD) is one of the most severe cardiac pathologies, which usually develops in the presence of witnesses, occurs instantly or in short period time and has as the main cause the coronary arteries.

The factor of surprise plays a decisive role in making such a diagnosis. As a rule, in the absence of signs of an impending threat to life, instantaneous death occurs within a few minutes. A slower development of the pathology is also possible, when arrhythmia, heart pain and other complaints appear, and the patient dies in the first six hours from the moment of their occurrence.

The greatest risk of sudden coronary death observed in persons 45-70 years old who have certain forms of disorders in the blood vessels, heart muscle, and its rhythm. Among young patients, there are 4 times more men; in old age, men are susceptible to pathology 7 times more often. In the seventh decade of life, gender differences are smoothed out, and the ratio of men and women with this pathology becomes 2:1.

Most patients sudden stop hearts are found at home, a fifth of cases occur on the street or in public transport. In both places there are witnesses to the attack who can quickly call an ambulance, and then the likelihood of a positive outcome will be much higher.

Saving a life may depend on the actions of others, so you cannot simply walk past a person who has suddenly fallen on the street or lost consciousness on a bus. You need to at least try to carry out the basic - indirect massage hearts and artificial respiration, having first called doctors for help. Cases of indifference are not rare, unfortunately, and therefore the percentage of unfavorable outcomes due to late resuscitation occurs.

Causes of sudden cardiac death

the main cause of SCD is atherosclerosis

The causes that can cause acute coronary death are very numerous, but they are always associated with changes in the heart and its blood vessels. The lion's share of sudden deaths occurs when coronary arteries fatty tissues are formed, obstructing blood flow. The patient may not be aware of their presence, may not make any complaints as such, then they say that it is completely healthy man died suddenly from.

heart attack

Another cause of cardiac arrest may be acutely developed, in which proper hemodynamics are impossible, the organs suffer from hypoxia, and the heart itself cannot withstand the load and.

• The causes of sudden cardiac death are:
• Cardiac ischemia; Congenital anomalies;
• coronary arteries
• arteries with endocarditis, implanted artificial valves;
• Spasm of the arteries of the heart, both against the background of atherosclerosis and without it;
• for hypertension, defect,;
• Metabolic diseases (amyloidosis, hemochromatosis);
• Congenital and acquired;
• Heart injuries and tumors;
• Physical overload;

Arrhythmias. Risk factors have been identified when the likelihood of acute coronary death becomes higher. The main such factors include ventricular tachycardia

, a previous episode of cardiac arrest, cases of loss of consciousness, previous history, reduction of the left ventricle to 40% or less. Secondary, but also significant conditions under which the risk of sudden death is increased are considered concomitant pathology , in particular, diabetes, obesity, myocardial hypertrophy, tachycardia more than 90 beats per minute. Smokers and those who neglect physical activity

Diagram: distribution of causes of SCD at a young age

For more careful monitoring and targeted examination groups of people at high risk of SCD have been identified. Among them:

1. Patients who have undergone resuscitation due to cardiac arrest or;
2. Patients with chronic failure and cardiac ischemia;
3. Persons with electric;
4. Those diagnosed with significant cardiac hypertrophy.

Depending on how quickly death occurred, instant cardiac death and rapid death are distinguished. In the first case, it occurs in a matter of seconds and minutes, in the second - within the next six hours from the onset of the attack.

Signs of sudden cardiac death

In a quarter of all cases of sudden death of adults, there were no previous symptoms; it occurred without obvious reasons. Other One to two weeks before the attack, patients noted a deterioration in their health in the form of:

• More frequent painful attacks in the region of the heart;
• Rise ;
• A noticeable decrease in performance, feelings of tiredness and fatigue;
• More frequent episodes of arrhythmia and interruptions in cardiac activity.

Before cardiovascular death pain in the heart area increases sharply, many patients manage to complain about it and experience strong fear, as happens with myocardial infarction. Maybe psychomotor agitation, the patient grabs the area of ​​the heart, breathes noisily and quickly, catches air with his mouth, sweating and redness of the face are possible.

Nine out of ten cases of sudden coronary death occur outside the home, often against the background of strong emotional distress, physical overload, but it happens that the patient dies from acute coronary pathology in a dream.

When ventricular fibrillation and cardiac arrest occur during an attack, severe weakness appears, dizziness begins, the patient loses consciousness and falls, breathing becomes noisy, and convulsions are possible due to deep hypoxia of the brain tissue.

On examination, pale skin is noted, the pupils dilate and stop responding to light, heart sounds cannot be heard due to their absence, the pulse is large vessels also not defined. In a matter of minutes, clinical death occurs with all its characteristic signs. Since the heart does not contract, the blood supply to everyone is disrupted. internal organs, therefore, within a few minutes after loss of consciousness and asystole, breathing disappears.

The brain is most sensitive to a lack of oxygen, and if the heart is not working, then 3-5 minutes are enough for its cells to begin irreversible changes. This circumstance requires immediate resuscitation measures, and the sooner chest compressions are provided, the higher the chances of survival and recovery.

Sudden death due to accompanying atherosclerosis of the arteries, then it is more often diagnosed in older people.

Among young such attacks can occur against the background of spasm of intact blood vessels, which is facilitated by the use of certain narcotic drugs(cocaine), hypothermia, overwhelming exercise stress. In such cases, the study will show no changes in the vessels of the heart, but myocardial hypertrophy may well be detected.

Signs of death from heart failure in acute coronary pathology will be pallor or cyanosis of the skin, rapid enlargement of the liver and neck veins, possible pulmonary edema, which is accompanied by shortness of breath up to 40 breathing movements per minute, severe anxiety and convulsions.

If the patient has already suffered from chronic organ failure, but edema, cyanosis of the skin, an enlarged liver, and expanded borders of the heart during percussion may indicate a cardiac origin of death. Often, when the ambulance team arrives, the patient’s relatives themselves indicate the presence of a previous chronic illness; they can provide doctors’ records and hospital extracts, then the diagnostic issue is somewhat simplified.

Diagnosis of sudden death syndrome

Unfortunately, cases of post-mortem diagnosis of sudden death are not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. At the autopsy, they do not find any pronounced changes in the heart that could cause death. The unexpectedness of what happened and the absence traumatic injuries speak in favor of the coronarogenic nature of the pathology.

After the arrival of the ambulance team and before the start of resuscitation measures, the condition of the patient, who by this time is already unconscious, is diagnosed. Breathing is absent or too rare, convulsive, the pulse cannot be felt, heart sounds cannot be detected on auscultation, the pupils do not respond to light.

The initial examination is carried out very quickly, usually a few minutes are enough to confirm the worst fears, after which doctors immediately begin resuscitation.

Important instrumental method Diagnosis of SCD is an ECG. With ventricular fibrillation, erratic waves of contractions appear on the ECG, the heart rate is above two hundred per minute, and soon these waves are replaced by a straight line, indicating cardiac arrest.

With ventricular flutter, the ECG recording resembles a sinusoid, gradually giving way to random waves of fibrillation and an isoline. Asystole characterizes cardiac arrest, so the cardiogram will show only a straight line.

Upon successful resuscitation prehospital stage, already in a hospital setting the patient will face numerous laboratory examinations, starting with routine urine and blood tests and ending with toxicological testing for certain drugs that can cause arrhythmia. Will definitely be held daily monitoring ECG, ultrasound examination heart, electrophysiological study, stress tests.

Treatment of sudden cardiac death

Since sudden cardiac death syndrome causes cardiac arrest and respiratory failure, the first step is to restore the functioning of life support organs. Emergency care should be started as early as possible and includes cardiopulmonary resuscitation and immediate transportation of the patient to the hospital.

At the prehospital stage, resuscitation options are limited; it is usually carried out by specialists emergency care who find the patient in the most different conditions– on the street, at home, in the workplace. It’s good if at the time of the attack there is a person nearby who knows her techniques - artificial respiration and chest compressions.

Video: Performing basic cardiopulmonary resuscitation

Ambulance team after diagnosis clinical death begins indirect cardiac massage and artificial ventilation lungs with an Ambu bag, provides access to a vein into which medications can be administered. In some cases, intratracheal or intracardiac administration of drugs is practiced. It is advisable to administer drugs into the trachea during intubation, and the intracardiac method is used most rarely - when it is impossible to use others.

In parallel with the main resuscitation actions, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart’s activity in this moment. If ventricular fibrillation is detected, then the most the best method its relief will become, and if the necessary device is not at hand, then the specialist delivers a blow to the precordial area and continues resuscitation measures.

defibrillation

If cardiac arrest is determined, there is no pulse, and there is a straight line on the cardiogram, then during general resuscitation the patient is given any in an accessible way adrenaline and atropine at intervals of 3-5 minutes, antiarrhythmic drugs, cardiac pacing is established, after 15 minutes sodium bicarbonate is added intravenously.

After the patient is admitted to the hospital, the fight for his life continues. It is necessary to stabilize the condition and begin treatment of the pathology that caused the attack. May need surgery, the indications for which are determined by doctors in the hospital based on the results of examinations.

Conservative treatment includes the administration of drugs to maintain blood pressure, heart function, and normalize electrolyte metabolism disorders. For this purpose, beta blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensive drugs or cardiotonics, infusion therapy:

• Lidocaine for ventricular fibrillation;
• Bradycardia is treated with atropine or isadrine;
• Hypotension is a reason for intravenous administration dopamine;
• Fresh frozen plasma, heparin, aspirin are indicated for DIC syndrome;
• Piracetam is administered to improve brain function;
• For hypokalemia - potassium chloride, polarizing mixtures.

Treatment in the post-resuscitation period lasts about a week. At this time, electrolyte disturbances, disseminated intravascular coagulation syndrome, neurological disorders, so the patient is admitted to the intensive care unit for observation.

Surgery may involve radiofrequency ablation of the myocardium - for tachyarrhythmias, the effectiveness reaches 90% or higher. If there is a tendency to atrial fibrillation, a cardioverter-defibrillator is implanted. Diagnosed atherosclerosis of the heart arteries as a cause of sudden death requires valvular heart surgery.

Unfortunately, it is not always possible to provide resuscitation measures within the first few minutes, but if it was possible to bring the patient back to life, then the prognosis is relatively good. As research data show, the organs of people who have suffered sudden cardiac death do not have significant and life-threatening changes, therefore maintenance therapy in accordance with the underlying pathology allows them to live for a long time after coronary death.

Prevention of sudden coronary death is needed for people with chronic diseases of cardio-vascular system, which can cause an attack, as well as for those who have already survived it and were successfully resuscitated.

To prevent a heart attack, a cardioverter defibrillator may be implanted, which is especially effective for serious arrhythmias. At the right moment, the device generates the impulse the heart needs and does not allow it to stop.

Requires medication support. Beta blockers and blockers are prescribed calcium channels, products containing omega-3 fatty acid. Surgical prophylaxis consists of operations aimed at eliminating arrhythmias - ablation, endocardial resection, cryodestruction.

Nonspecific measures to prevent cardiac death are the same as for any other cardiac or vascular pathology – healthy image life, physical activity, refusal bad habits, proper nutrition.

Video: Presentation on Sudden Cardiac Death

Video: lecture on the prevention of sudden cardiac death

Many people dream of dying in their sleep, so that there would be no torment, agony, pain– that’s all, but few people know that sudden death can also happen while a person is awake.

What is sudden nocturnal death syndrome

Sudden nocturnal death syndrome was first recorded as independent disease in the 80s of the twentieth century. Then the American Center for Disease Control in the United States recorded a high rate of sudden death among young men (25 per 100,000 people), all of whom were mainly from Southeast Asia.

They all died at night, in their sleep, and there were no recorded lesions of the heart muscle or coronary vessels. The age of these men was 20-49 years, and most of them overweight they did not suffer and led a healthy lifestyle (did not drink alcohol, did not smoke, and did not take drugs). It is very interesting that African Americans are not affected by this disease.

The first description of sudden nocturnal death syndrome is found in the medical literature of cases in 1917 in the Philippines, where the syndrome was named bangungut, and in Japan in 1959 the syndrome was called pokkuri. They wrote about him almost all over Asia.

How does sudden nocturnal death syndrome occur?

Most cases of such death, that is, 65%, occurred in front of witnesses, while the rest were found in a sleeping position. It is also known that in 94% of cases death occurred within an hour from the beginning of the agony, it manifested itself in this way:

• At first the person sleeps peacefully;
• Then he begins to moan and wheeze;
• Then snoring begins, the patient does not have enough air (suffocates);
• And then death comes.

Trying to wake a person at this moment is useless.

Many Hmong men who arrived in America and lived there for just under a year died in their sleep from sudden nocturnal death syndrome. IN Lately on scientific conferences discuss this strange syndrome.

So, Shelley Adler wanted to find out more information and interviewed Hmong men, while at the same time re-read all the scientific sources that covered this topic. After that, she wrote a book dedicated to her research on the influence of human consciousness on his biology.

In scientific works this phenomenon is called sleep paralysis. People at this moment enter special condition– muscle paralysis occurs before falling asleep or during awakening, which is each time accompanied by a feeling of strong fear.

All adult Hmong men associate sleep paralysis with the arrival of an evil spirit. The Indonesians call this spirit dijonton, the Chinese call it bey gi ya, and the residents of Newfoundland call it old hag (kikimora). And translated from Dutch it means “night witch.”

IN different cultures the visit of this spirit is described in the same way. People attacked by this spirit think that they are not dreaming - everything is so realistic. But, despite this, the person cannot move, from this horror comes to him, since he realizes that someone is squeezing his chest, it becomes impossible to breathe and he cannot move at all.

One of Shelley Adler’s interlocutors said that he experienced sleep paralysis twice in his life. He could not describe the fullness of his sensations, this inexplicable state - next to him he felt evil that appeared from nowhere, it was very disgusting, it was approaching, but he knew that he would remain alive. He finally woke up in a state of horror that he had never experienced before.

But despite this, there is a difference between sleep paralysis and what the Hmong people experienced in the 80s, since sleep paralysis is always harmless, and the Hmong died after it.

Shelley concluded that people were dying due to strong faith in evil spirits, that if the Hmong do not observe their rituals, pray correctly and make sacrifices, then an evil spirit will come for them.

In this regard, we can say that they had too much strong impact faith on biological processes body. They, so to speak, set themselves up for an untimely death.

Of course, in our time little is known about the relationship between consciousness and body, but studying the issue sleep paralysis, perhaps in the near future this mystery will be solved.

Video on the topic of the article

Why do people die in their sleep? Should they even die in their sleep?

Sleep has always been associated with rest, relaxation, restoration of strength and energy. How long-awaited it is after a difficult working day! Good, quality sleep protects us from infections during epidemics of acute respiratory infections. A well-rested person feels better, his physical and mental form many times better than those who did not get enough sleep. People who sleep well accomplish more and earn more, are less late, and are 6 times less likely to get into an accident. And in general, they are more successful and happy in life.

So why, nevertheless, about a third of all deaths occur during sleep, and in the morning, when sleep is deepest? Because the sleep of such people is altered. It's not just of poor quality or short duration. People at high risk of dying in their sleep have serious violations breathing and heart function, which appear only during sleep.

Obstructive sleep apnea syndrome

The most common reason death in sleep - obstructive sleep apnea syndrome, when snoring is interrupted by a long pause without breathing. At this moment, the walls of the pharynx stick together and do not allow the air flow to pass further, and the oxygen in the blood gradually runs out. Typically, after a few seconds this situation triggers defense mechanisms body, the brain wakes up, restoring control over inhalation and exhalation. However, for this to happen, the pulse must increase, the heart must begin to work faster and harder, and the level of adrenaline and blood pressure must rise, as during physical activity.

If interruptions in breathing are short-term and occur less than five per hour, then there may be no consequences. But the more often and harder apnea syndrome, the worse the body feels. Ultimately, the nutrition of the heart deteriorates right during respiratory arrest, leading to chest pain and ischemia of the heart muscle. At long-term deficiency oxygen, myocardial infarction develops. To save resources, the heart can slow down, and this provokes arrhythmias ( atrial fibrillation or paroxysmal tachycardia), blockade of electrical impulses through the heart (atrioventricular and sinoatrial blockades) and even cardiac arrest.

Not every person can handle this, especially if it happens every night, several times. With severe obstructive sleep apnea, there can be up to 500 breathing stops per night, and the total time when a person is not breathing can reach several hours. It is not surprising that the heart and blood vessels cannot stand it, and everything ends tragically.

Diagnosis of apnea

Considering that all processes in a dream are invisible to the sleeper, you may not be aware of a serious threat of death. The only sign high risk heart attack or stroke may cause snoring. Less commonly, with severe sleep apnea, it may increase in the morning. arterial pressure, bother headache, and suffer from drowsiness during the day.

You can consult a somnologist about sleep quality, the presence and degree of apnea. If you're concerned about the quality of your sleep, get a sleep apnea assessment to understand how you breathe while you sleep. Remember that among the causes of apnea, a large share is occupied by dental reasons! Malocclusion and tooth loss lead to sleep apnea in most cases. That is why the Dial-Dent dental center treats sleep disorders.