Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 330-342
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.330
Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence
Nils J Bergman
Nils J Bergman, School of Child and Adolescent Health, University of Cape Town, Rondebosch 7700, South Africa
Author contributions: Bergman NJ was the sole author of this work.
Institutional review board statement: Not applicable.
Informed consent statement: Not applicable.
Conflict-of-interest statement: Author has no financial relationships or other conflict of interest relevant to this article to disclose.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Nils J Bergman, MB ChB, MPH, MD, School of Child and Adolescent Health, University of Cape Town, Private Bag X3, Rondebosch 7700, South Africa. nils@ninobirth.org
Telephone: +27-21-5315819 Fax: +27-21-5315819
Received: April 1, 2016
Peer-review started: April 6, 2016
First decision: May 17, 2016
Revised: May 26, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 8, 2016
Processing time: 127 Days and 22.9 Hours
Abstract

AIM: To identify a hypothesis on: Supine sleep, sudden infant death syndrome (SIDS) reduction and association with increasing autism incidence.

METHODS: Literature was searched for autism spectrum disorder incidence time trends, with correlation of change-points matching supine sleep campaigns. A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.

RESULTS: In five countries (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, change-points coinciding with supine sleep campaigns were identified. The model proposes that supine sleep does not directly cause autism, but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility, thereby specifically increasing the incidence of autism without intellectual disability.

CONCLUSION: Supine sleep is likely a physiological stressor, that does reduce SIDS, but at the cost of impact on emotional and social development in the population, a portion of which will be susceptible to, and consequently express autism. A re-evaluation of all benefits and harms of supine sleep is warranted. If the SIDS mechanism proposed and autism model presented can be verified, the research agenda may be better directed, in order to further decrease SIDS, and reduce autism incidence.

Keywords: Autism; Autism spectrum disorder; Incidence; Prevalence; Prone sleep; Sudden infant death syndrome; Supine sleep; Time trends

Core tip: An earlier article presents evidence that supine sleep is a stressor, with sympathetic arousal that protects infants with defects in auto-resuscitation from sudden infant death syndrome. This article argues that a possible side-effect in the population being subjected to supine sleep is an increase in the expression of features contributing to diagnosis of autism spectrum disorder. In a literature search, five countries were identified (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, and with change-points coinciding with supine sleep campaigns. The stressor hypothesis for both conditions are amenable to testing, a better understanding of both is likely to improve outcomes.