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March 2, 1970

To Sleep: To Die

JAMA. 1970;211(9):1535-1536. doi:10.1001/jama.1970.03170090051011

"... To die: to sleep. To sleep: perchance to dream: ay, there's the rub..."

Hamlet's soliloquy obviously does not imply an association of sleep, dreams, and death in the context of coronary artery disease. This association was in fact denied as recently as 1937 when Master, Dack, and Jaffe1 studied the factors and events associated with the onset of coronary artery thrombosis. Without critical analysis, the stresses known to induce angina pectoris had previously been thought also to cause coronary thrombosis. Theirs was to be the critical analysis.

After a study of 817 attacks of coronary occlusion in 555 patients, they concluded that, although coronary artery sclerosis is the main underlying cause of both angina pectoris and coronary artery thrombosis, the two conditions differ entirely as regards the exciting cause of the attack. Thrombosis, unlike angina, seemed unrelated in onset to exertion, excitement, or eating.

Without respect to the validity