Intriguing Sleep Apnea and Autism Connections

November 5, 2009

I stumbled across this blog post, where I discovered an interesting discussion on the possible link between the sudden rise of newly diagnosed autism cases and the onset of the "back to sleep" campaign in 1992. This is when the American Academy of Pediatrics recommended that all infants up to one year old be placed on their backs while sleeping. Due to this recommendation, the rate of SIDS (sudden infant death syndrome) dropped about 40% (from 1992 to 1999). During this same time period, the rate of infants placed on their backs increased from about 10% to almost 70%. Coincidentally, the rate of autism rose sharply as well.

The person proposing this association (Thomas McCabe) has made it clear that infants, by being placed on their backs, have less efficient sleep due to more frequent obstructions and arousals. He sites numerous studies and papers showing that stomach sleeping results in much lower arousals, shorter length of breathing pauses, and lower rates of body movements and sighs. Another study showed that infants sleeping on their stomachs slept 8.3% more than back sleepers.

He cites various other papers that report developmental and neurocognitive delays in back sleepers in the first 6 months compared with stomach sleepers. Furthermore, McCabe states that back sleeping interference with deep sleep (slow wave sleep – SWS) as well as REM sleep. Both are important for memory consolidation and cognitive function. What he’s suggesting is the possibly that all at-risk infants undergo some sort of screening EEGs and place those infants highest at-risk on CPAP.

It’s a little technical, but take a look at his posts, as well as his e-book. His ideas may sound radical, but worth considering, in light of the fact that now in certain parts of NJ, about 1% of all boys have autism or some variation.

It’s important to point out that SIDS peaks at around 2-4 months. Not too surprisingly, this is also the same timeframe when the baby’s voice box descends and separates aways from the soft palate, allowing the tongue to move further back into the throat. This is when they go from obligate nose breathers to oral and nose breathers. During this transitional state, the baby has to relearn how to swallow and breathe.

Based on what I’m discovering every day about our health and sleep-breathing problems, I would’t be surprised if this hypothesis turned out to be true. Of course, more definitive research must be done to prove this hypothesis. Unfortunately, the orthodox medical profession doesn’t like to admit it was wrong, so it won’t even consider asking if there’s any merit to this possible link.

Our infants have been sleeping on their stomachs for almost all of known history. Although it’s hard to argue with the SIDS data and the significant lowering of infant deaths, but there’s something unnatural about changing our natural sleep positions all of a sudden 17 years ago.

Even my youngest son Brennan naturally rolled over onto his stomach while sleeping as soon as he was able to.

Should the medical community at least take another look at this issue? Please reply with your comments below.

Written by Steven Park · Filed Under Blog | 16 Comments

Sudden Infant Death Syndrome & Obstructive Sleep Apnea

May 22, 2009

I recently stumbled upon a handful of studies about sudden infant death syndrome (SIDS) in a book on sleep apnea by Dr. Allan Pack. SIDS is a tragic condition where an infant dies suddenly in the first year of life or no apparent reason. Apparent life threatening events (ALTEs, or near-miss SIDS) are episodes then a child stops breathing, but comes back to life. Not too surprisingly, Dr. Christian Guilleminault (who published the original paper on upper airway resistance syndrome, and the link between sleep apnea and cluster headaches and sleep walking) and colleagues reported that in 3/5 families of children with SIDS or near-miss SIDS, parents and grandparents had elevated AHIs and excessive sleepiness. All seven children in this study with near-miss SIDS were found to have obstructive sleep apnea at 12 months.

In a follow-up study, Guilleminault followed 25 children with near-miss SIDS (by 4.5 months) in a group of 700 that required sleep studies for over one year. All 25 were found to have obstructive sleep apnea by age 5. Deray, et al found that loud snoring frequency in fathers of SIDS or near-miss SIDS children was over 2 times that of control. It was stated clearly that this is a subgroup of all children with SIDS, but my gut feeling is that it’s much bigger than they think it is.

I alluded to another study in a past post where breast-feeding was found to lower SIDS rates. I’ve presented evidence that bottle-feeding may increase the chances of developing obstructive sleep apnea. It’s interesting to note that the peak incidence of SIDS occurs around 4-6 months. This is also the time that the infant’s voice box descends and separates away from the soft palate. This transitional period can be a dangerous time for infants, as they go from obligate nasal breathers (when they can suckle and breathe in parallel) to nasal and mouth breathers.

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Breast Feeding Protects Against Crib Death / SIDS

May 10, 2009

Breastfeeding was found to cut SIDS (sudden infant death syndrome) rates in half. A recent paper published in Pediatrics confirmed previous suspicions about the benefits of breastfeeding on the incidence of SIDS.

This study supports my sleep-breathing paradigm, which is also supported by Dr. Brian Palmer’s assertion that bottle-feeding promotes dental crowding and development of obstructive sleep apnea. The jaw narrowing that results persists into childhood and adulthood, leading to smaller breathing passageways. It’s interesting to note that the peak incidence of SIDS is around 4-6 months. Coincidentally, this is also the time of transition where infants go from obligate nose breathers to mouth and nose breathers.

During this transition, the voice box slowly drops to a position under the tongue, which creates a space behind the tongue that only humans have (the oropharynx). This new anatomy is necessary for complex speech and language ability. During this time, the infant has to adjust to different breathing, swallowing and speaking abilities and you can imagine that problems can occur during this time.

Comparative anatomists and evolutionary biologists have said that speech and language development was ultimately detrimental to humans. If you have a common channel that has to serve breathing, swallowing and communication, then overdevelopment of one can detrimentally affect the other two. This is why only humans have so many problems breathing and swallowing.

As I mention in my book, Sleep, Interrupted, our transition in the past few centuries to more processed foods and highly refined sugars, along with bottle feeding, aggravated this problem by causing even more dental crowding and upper airway narrowing.

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