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The Common Link Between Autism, ADHD, Bipolar, Depression, Schizophrenia: Genes or Upper Airway Anatomy?

Here’s an interesting study showing that there’s a common genetic basis to five common mental health conditions: autism, ADHD, depression, schizophrenia, and bipolar disease. In particular, single nucleotide polymorphisms (SNPs) in two genes involved in calcium-channel activity appear to play a role in all five conditions. This finding was reported in the Journal Lancet by doctors at the Massachusetts General Hospital. 

I’ve written about many of these conditions as it relates to obstructive sleep apnea in the past. There have been many published studies showing how damaging lack of oxygen is to the brain, especially in young developing brains. It’s not too far fetched to imagine how brain biochemistry can be radically changed when subjected to poor sleep and hypoxia.

I mentioned in my last post that even one week of insufficient sleep has been found to affect gene expression in areas of  chromatin remodeling, regulation of gene expression, and immune and stress responses. Perhaps the common mental health “gene” affects calcium channels as well as to determine the ultimate size of your jaws and upper airway.

Why Obese Women Are More Likely To Have Austistic Children

The origins of autism is a very controversial subject, but I’ve always suspected that that there are a number of different ways that poor breathing and lack of brain oxygenation can be detrimental to optimal brain development. Here’s a study showing that pregnant women who are obese were 67% more likely to have children with autism compared to normal weight mothers. This study also revealed that mothers with diabetes were nearly twice as likely as healthy mothers to have children with developmental disorders. Their explanation is that diabetes and obesity causes inflammatory chemicals to cross the placenta to disrupt fetal brain development. While this could be true, having prolonged periods of hypoxia from untreated obstructive sleep apnea in pregnant women is an even better reason for a potential  developmental brain disorders, as well as diabetes.

Obese Women More Likely to Have Children with Autism

Here’s a not-to-surprising study showing that obese women are at higher risk of having children with autism. Obese women were 67% more likely to have an autistic child, and about 2x as likely to have an child with another developmental disorder. Having gestational diabetes also raised by 2x a mother’s risk of having a baby with developmental disorders.

They also note that nearly 60% of women of childbearing age in the US is overweight and about 1/3 are obese. Obesity rates are rapidly climbing. Autism rates are also climbing, with the latest report showing 1/88 children having one of the autism spectrum disorders.

The authors mentioned every possible explanation (diabetes, high blood pressure, fluctuating glucose levels, lack of oxygen) expect for obstructive sleep apnea. I’ve written numerous times in the past about complications of obstructive sleep apnea during pregnancy. If you’re overweight or obese, you’re much more likely to have obstructive sleep apnea. One of the hallmarks of sleep apnea is hypoxia and major physiologic stress on the mother’s body. I wonder what the effect is on the developing baby’s brain? It would make sense to routinely screen for sleep apnea in all women, especially if you’re overweight or heavier.

If you were overweight during pregnancy, did your doctor screen you for obstructive sleep apnea? 

Missing Teeth = Poor Health?

Ever since I began seeing patients in my new position at Montefiore medical center, I’ve been surprised by how many patients have missing teeth. In fact, many have no teeth at all, and often have to wear dentures, especially if they’re in the elderly years. Not too surprisingly, these same patients also have a number of chronic medical conditions, such as hypertension, diabetes, high cholesterol, heart disease, as well as numerous medications for these respective conditions. Many are obese.

Being in a major tertiary-care referral-based hospital, it’s expected that patients will have complex medical issues. But this observation only supports what dentists have been saying for years—that poor dental health equals poor general health. Not only do I see multiple missing teeth, there’s also significant jaw narrowing and crowding of the soft tissues of the mouth. Having smaller airways due to missing teeth and smaller jaws can aggravate significant medical problems, such as hypertension, diabetes, high cholesterol, and heart disease.

We’re seeing an epidemic of jaw underdevelopment these days, with dental crowding and numerous orthodontic and airway issues that arise as a result. The rise in premature babies, modern feeding habits, nutritional factors, and various toxins in our environment can prevent proper facial growth and development. It’s no wonder that we’re seeing increasing rates of ADHD, autism, and various other developmental delays. These are the same kids that will go on the develop high blood pressure, diabetes, obesity, high cholesterol, and heart disease later in adulthood.

You could argue that having bad teeth is a consequence of the particular population that we serve, but knowing what we know about the importance of proper jaw development and dental health, it’s likely that poor dental issues also predisposes people to chronic medical problems.

 

What do you think about my observations? 

The ADHD & Autism Spectrum Disorder Epidemic

A recent guest post on KevinMD’s blog points out that the rate of autism spectrum disorders (ASD) has increased 57% from 2002 to 2006. Currently, about 1 out of every 100 children born are thought to have ASD. It’s estimated that about 60 to 70% of ASD are from environmental factors, whereas 30-40% are due to genetic issues. The writer, Philip Landrigan, focuses on the possible environmental causes of autism and ADHD (attention deficit hyperactivity disorder), arguing that there are now over 80,000 synthetic chemicals that have been developed over the past 50 years. Many of these compounds have been shown to be toxic to developing brains in children. Currently 200 are toxic in adult humans, and another 1,000 are toxic in experimental models.

I have no doubt that many synthetic chemicals can be toxic to childen and adults, including some pharmaceutical products. In the world that we live in, with all the conveniences of modern life, we’re inundated to a multitude of synthetic chemicals, many of which are safe, but some are not.

However, one area that ASD and ADHD researchers almost never bring up during discussions is the fact that sleep-breathing problems are also progressing over time. Having smaller jaws and dental crowding leads to smaller airways, with leads to frequent breathing problems during sleep, with fragmented sleep. Lack of continuous, deep, efficient sleep has been shown to cause a number of biochemical, hormonal, and neurologic changes in the brain, usually for the worse. Countless times, I see children on stimulants for ADHD come off their medications after their large tonsils are taken out. Almost invariably, one or both parents of children with ASD or ADHD have major snoring or sleep apnea. 

Clearly, not everyone with ADHD or ASD has sleep-breathing problems, and not all areas of obstruction are due to large tonsils. However, even if 1/3 of these children have an underlying sleep-breathing problem (some have suggested 50%), wouldn’t it make sense to routinely screen for snoring and sleep apnea in any child with ADHS or ASD? 

ADHD & Autism Rates Spike—Is Sleep Apnea Responsible?

Researchers were surprised that that rate of ADHD and autism have spiked over the last 10 years. ADHD increased 33%, whereas autism increased from 0.19% to 0.74% over the same time period. Honestly, I’m not surprised by these results. Here’s my explanation for the continued rise in these two common developmental disorders:

1. There’s definitely more awareness of these two conditions (ADHD and autism), as well as more inclusive criteria for diagnosis
2. Implementation of the back to sleep campaign about 20 years ago
3. Worsened diet
4. Bottle-feeding
5. Environmental endocrine disruptors
6. Less total sleep time
7. increased incidence of allergies and food sensitivities.

There’s even evidence showing that common motor-skill milestones are often coming in delayed, since infants are not spending as much time on their tummies, even during the day. As expected, skull deformities (flat head) are much more common since the back to sleep campaign.

What does this have to do with obstructive sleep apnea? Here are 3 important reasons:

1. Factors 2 to 6 all significantly increase your risk for obstructive sleep apnea, through either poor jaw development or inflammation of the upper airway.
2. Obstructive sleep apnea can predispose to obesity, which narrows your airway even further
   
3. Sleep-breathing problems begin during infancy, and the lack of deep, efficient sleep, not to mention frank hypoxia from apneas, can be detrimental to the infant’s brain development and biochemical pathways.

I realize that there are a number of other possible reasons for ADHD or autism (probably a combination of many factors), but not getting deep sleep can be a major barrier to proper brain development. Studies are definitely needed in this matter. Unfortunately, the medical/pharmaceutical industry is unlikely to change the status quo.

What do you think about this study? It is from over-reporting or more awareness, or is it for real?

 

 

 

Asthma Rates Spike, Helped By Sleep Apnea?

Researchers are puzzled as to why there seems to be a significant rise on rates of asthma in children compared to previous years. A new study released from the CDC reported that nearly one in 10 children and one in 12 Americans have asthma. From 2001 to 2009, the overall rate of asthma increased 12.3%. In 2007, it cost $57 billion to care for asthma patients.

Despite lower rates of smoking and second-hand smoke, the prevalence of asthma increased in all demographic groups, including men, women, whites, blacks, and Hispanics. Possible reasons for this sudden increase include various allergens, traffic fumes, pesticides, certain plastics, diet and obesity.

Here’s one more possibility: Obstructive sleep apnea. We know that children are more overweight than ever, and along with this it’s expected that sleep apnea will increase as well. Multiple breathing pauses at night can literally suction up your stomach juices into your throat, which can then reach your nose or your lungs. This causes your nose and your lungs to become inflamed and overreactive to allergies, fumes, and even weather changes. Lack of deep sleep also causes your nervous system and your immune system to become hypersensitive, aggravating this vicious cycle.

Notice how it’s not just asthma rates that are going up. Many of the other childhood related conditions are going up as well: obesity, ADHD, autism, allergies, etc. These are all part of the same continuum that unfortunately, are treated as independent conditions. With multiple breathing pauses at night, any of these conditions can occur or aggravate an already existing condition.

If you have asthma, how many of you can’t sleep on your back? (I’ll tell you why I ask this question a bit later.)

 

 

SIDS, Back Sleeping, and Sleep Apnea?

I was doing some research on the internet about sleep position and SIDS (sudden infant death syndrome) and came across a blog post that says exactly what I was going to say, but in much more detail, and with a critical analysis of the statistics used when the American Academy of Pediatrics recommended that all infants be kept on their backs while sleeping. This campaign has lowered the rate of SIDS by about 50%, but about 3000 infants still die from SIDS every year.

Reading this story is heart-wrenching. It’s a long post, but I strongly recommend that you read through it. I frequently see parents in my practice that are literally in tears when they are berated by their pediatricians to keep their infants on their backs, despite the fact that their child can’t sleep in this position.

Sleep and pediatric researchers have shown that one possible mechanism as to why back sleeping helps to prevent SIDS is that it keeps babies in a lighter stage of sleep. This makes them much more easily aroused. If there is some kind of dangerous breathing stoppage, they’re more likely to wake up and start breathing again. What he also points out is that deep sleep is diminished by 8-9% in infants that sleep on their backs for the first 6 months. He calculated that back sleeping infants lose about 4 hours of sleep per day and 120 hours of sleep in the first month. We know that quality sleep is so important to an infant’s brain development and motor skills.

So it’s not surprising that there’s been an increase in rates of motor skill, cognitive and other developmental delays. Other studies have shown increased rates of sleep apnea, flat-head (my second son had this), and acid reflux. There’s even one blog that points to the back to sleep campaign as a major cause of the autism spike that began in the mid 1990s. I’ve also suspected that the decreasing rates of tonsillectomies in the 1980s and 1990s may adversely affect cognitive development (ADHD).

Numerous studies have shown that there are a number of other significant risk factors that increase the risk for SIDS, including bed-sharing, cold weather months, smoking, and soft bedding, whereas pacifier use and breast-feeding are protective. African Americans and Native Americans had significantly higher rates.

One major anatomic reason for SIDS is the fact the the infant’s voice box is very high in the throat, behind the tongue, with the epiglottis overlapping the soft palate. Gradually, over the course of 2-4 months, the voice box begins to descend. At a certain point, the collapsibility of the tongue into the newly created oropharynx may reach a critical point when various factors come into play (sleep stage, sleep position, cigarette smoke, etc). This timeframe is also when the rate of SIDS peaks.

In particular, the author points out that most SIDS studies use an odds ratio calculation that can easily overestimate the true risk, and is often confused with relative risk. Because these studies are retrospective studies with relatively small numbers of subjects along with a number of different variables, odds ratio is used over relative risk. The explanation of the difference between odds ratio and relative risk is a bit lengthy so I recommend you read the article, which is very clear. He hammers on the concept that correlation does not equate with causation. To date there’s no good explanation for SIDS, which still happens in about 1/1000 babies, of which 1/3 die while on their backs.

One interesting statistic that he pointed out is the fact the the risk of dying from SIDS if you have no other risk factors is only 10% (including no tummy sleeping) of the original risk. He poses this interesting question: Is it worth sleep depriving all infants of 25% of sleep in the first few months to protect less than 0.1% of babies?

I’m not recommending that everyone go against mainstream medicine’s recommendations. However, we need to re-evaluate the rationale for this recommendation and consider all the possible unintended consequences.

What are your thoughts on this subject?

 

 

 

Expert Interview: Dr. Mack Jones on Neurologic Complications of Sleep Apnea

In this month’s Expert Interview, I talk with Dr. Mack Jones, neurologist, sleep physician, and author of the book, Deadly Sleep: Is Your Sleep Killing You? about some of the major neurologic complications of obstructive sleep apnea. In this fascinating and provocative discussion, Dr. Jones and I talk about:

- How sleep apnea can cause Alzheimer’s disease

- The link between multiple sclerosis and sleep apnea

- How ADHD and autism can be caused by sleep-breathing problems

- Seizures and sleep apnea

- And much more….

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Written by Steven Park · Filed Under Expert Interviews | 4 Comments 

The Tummy Time Controversy

December 3, 2010

As you may know by now, sleep position is a very important issue for me and I write about it quite often. When I recently came across this article in Slate magazine, I just had to comment. The gist of the article is that since the start of the back to sleep campaign in 1992, the rate of SIDS (sudden infant death syndrome) has been cut 50%. But there seems to be a downside: Parents are being overly cautious and not allowing enough tummy time when their children are awake. As a result, it’s been suggested that motor skill development such as lifting the head or rolling over, has been significantly delayed.

The arguments in this article are plausible, but a more immediate issue that’s completely being ignored is the fact then when babies are forced to sleep on their backs, by definition, you’re preventing them from staying in deep sleep. The thinking is that supine sleep allows infants to wake up easier if they ever obstruct. There are tomes of data that show that lack of deep sleep can have significant detrimental effects on your memory consolidation, affect, executive functioning, and motor skills. Imagine what can happen if you force this on an infant’s developing brain. It’s no wonder there’s been an epidemic of pediatric developmental, behavioral, and medical problems in the past few decades. It’s even been suggested that the incidence of  autism spiked just after the back to sleep campaign was implemented.

Honestly, I don’t know what the right answer is. I’m not saying that we should place all our infants on their stomachs. However, this is an important issue that needs to be discussed, even if it means that the medical profession has to admit this was not the best thing to do.

What’s your opinion on this issue? How well was your baby able to sleep on his or her back?

Written by Steven Park · Filed Under Blog | 6 Comments 

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