Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence.
OBJECTIVE
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.


CONCLUSIONS
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.
Nils J Bergman, School of Child and Adolescent Health, University of Cape Town, Rondebosch 7700, South Africa.
Nils J
NJ
Bergman
Autism; Autism spectrum disorder; Incidence; Prevalence; Prone sleep; Sudden infant death syndrome; Supine sleep; Time trends