Autism, Sleep Disordered Breathing, and Intracranial Hypertension: The Circumstantial Evidence

The ASD/OSA hypothesis as proposed in this paper will incorporate over 90 pieces of the "autism puzzle". It is suggested that the cause of autism is four-fold, requiring that: 1) the mother has sleep disordered breathing (SDB) during her pregnancy, 2) the infant is born with sleep disordered breathing, 3) both mother and infant have polymorphisms of the methylation pathway which are then triggered by the SDB, and 4) the infant is prone to intracranial hypertension. This theory can explain many, if not most, of the pieces of information that we currently know about the biology of autism. The fact that the sleep disordered breathing (SDB) in autism and in the mothers of autistic children has not been previously noted is due to flaws in the current methods for detecting SDB. Esophageal manometry is much more sensitive for detecting SDB but is not used routinely, however it may be more accurate than the apnea hypopnea index in terms of correlation with disruptive behavior disorders. There is evidence that SDB is much more common than previously believed. Apneas are known to increase intracranial pressure, and intracranial hypertension can be caused by obstructive sleep apnea. Recent studies showing behavioral problems and special needs correlated with SDB urge further evaluation of autistic children for SDB. The ASD/OSA hypothesis suggests that autism might be primarily prevented by detecting and treating SDB in women prior to conception, and in infants shortly after birth. Correspondence: Dr. Deborah E. Wardly, 7901 Autumn Gate Avenue, Las Vegas, NV 89131, USA. PHONE: 916-712-0704. FAX: 505-212-1712. E-MAIL: [email protected] Received on May 10, 2013; accepted on October 30, 2013. R E V IE W & H Y P O T H E S IS