Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.330
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
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.
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.