Early on February 19, Brian C. Vigneault was nearing the end of a 24-hour marathon of live streaming himself playing the tank warfare video game World of Tanks when he left his computer to buy a pack of cigarettes. He never returned.

During the break, Vigneault died in his Virginia Beach, Virginia, home. The medical examiner's office in Norfolk, Viriginia, said that Vigneault's cause of death had not yet been determined. There was no indication of foul play, according to police in Virginia Beach.

But Vigneault's friends wonder if the lengthy live streaming on Twitch, a website owned by Amazon that lets people broadcast themselves playing games, may not have helped. At the time of his death, Vigneault, 35, had streamed for 22 hours straight to raise money for the Make-A-Wish Foundation. Two of his friends said that he often broadcast his game playing for long periods.

"He was looking really tired on the stream," said Jessica Gebauer, a live streamer and a friend of Vigneault's. "We were telling him, 'Just to go to bed. It's not a big deal. Nobody's going to worry about it.'"

Calls to phone numbers registered under the names of Vigneault and his family members were not returned, and messages left were not answered. Gebauer said Vigneault's family did not want to comment.

Vigneault's death followed reports of other players dying during or after lengthy gaming sessions in Taiwan and South Korea, intensifying a discussion about the health risks of a streaming culture that rewards people for staying online for long periods. At least one video game streamer has blamed long bouts of live streaming for his emergency heart surgery, and others have written about the potential dangers of playing for hours on end.

Live streaming of video game playing has become popular in recent years. The activity has taken centre stage on sites like YouTube and Twitch, which has nearly 10 million daily visitors. Professional game streamers, who often combine the prowess of an elite player with the patter of a talk radio disc jockey, can sometimes make a living off these sites through advertising, subscriptions and other revenue sources.

Yet would-be professional streamers typically endure a relentless grind to build an audience. Anytime they leave their computers, they risk having followers peel away to another channel. The resulting lifestyle is often unhealthy, requiring long sedentary periods with little sleep. Some gamers are fuelled by junk food, caffeine and alcohol.

The streaming lifestyle, like that of some other stationary professions, "intuitively and medically seems such an unwise way to spend one's years," said Dr. James A. Levine, a professor of medicine at the Mayo Clinic who studies obesity and is the author of Get Up! Why Your Chair Is Killing You and What You Can Do About It. The upshot may be health problems including cardiovascular disease and diabetes, he said.

Twitch's community guidelines bar destructive behaviour, without directly addressing what some perceive as excessively long periods of playing. In an email, a Twitch spokesman said of Vigneault that "we are greatly saddened about the passing of one of the Twitch community."

Wargaming, the company that makes World of Tanks, wrote in an email that it was "saddened to hear of the loss of streamer and tanker Brian Vigneault".

Ben Bowman, 30, a professional Twitch streamer with more than 579,000 followers, published an article on the video game website Polygon in January about the pressure to stream constantly, which he said in an interview could lead to exhaustion, high cholesterol and heart problems. He said he had developed a herniated disk from sitting for hours each day with no breaks because he wanted to attract the biggest audience possible on Twitch.

"As a business thing, doing a 24-hour stream allows you to stretch the widest net," Bowman said. "There's a cultural understanding that you have to be on eight to 12 hours a day with no breaks. I used my channel like that and that took a really massive toll on me."

Other game streamers have found a way to sustain a large following and a healthy lifestyle. Rob Garcia, who has streamed the widely popular multiplayer fantasy game World of Warcraft on Twitch for six years and has more than 532,000 followers, said he regularly broadcast for 17 hours a day up to seven days a week at his peak in 2011.

"People were loving it. They were like, 'This guy never goes offline,'" Garcia said. "It became really bad for me."

Garcia, 36, said his weight had ballooned to 420 pounds from around 280 pounds. He resolved to change things in 2011 after he could no longer walk for 15 minutes without losing his breath. Late that year, he started a strict diet and exercise program that helped reduce his weight to around 250 pounds by 2015. He now works out with a trainer four times a week and often takes days and evenings off.

"There was a point in my streaming where I lost a lot of my viewers because I wasn't binge eating and binge drinking – they like to see the extreme stuff," Garcia said. "But my core viewers stuck around, and for them, it was amazing."

New York Times