MEDICAL HYPOTHESES AND RESEARCH
VOL. 9, No. 1/2, December 2014
D. E. Wardly  Med. Hypotheses Res. 9: 17-49.
Autism, Sleep Disordered Breathing, and Intracranial
Hypertension: The Circumstantial Evidence
Abstract. The ASD/OSA hypothesis as proposed in this paper will incorporate over 90
pieces of the "autism puzzle". It is suggested that the cause of autism is four-fold, requiring
that: 1) the mother has sleep disordered breathing (SDB) during her pregnancy, 2) the infant
is born with sleep disordered breathing, 3) both mother and infant have polymorphisms of
the methylation pathway which are then triggered by the SDB, and 4) the infant is prone to
intracranial hypertension. This theory can explain many, if not most, of the pieces of
information that we currently know about the biology of autism. The fact that the sleep
disordered breathing (SDB) in autism and in the mothers of autistic children has not been
previously noted is due to flaws in the current methods for detecting SDB. Esophageal
manometry is much more sensitive for detecting SDB but is not used routinely, however it
may be more accurate than the apnea hypopnea index in terms of correlation with disruptive
behavior disorders. There is evidence that SDB is much more common than previously
believed. Apneas are known to increase intracranial pressure, and intracranial hypertension
can be caused by obstructive sleep apnea. Recent studies showing behavioral problems and
special needs correlated with SDB urge further evaluation of autistic children for SDB. The
ASD/OSA hypothesis suggests that autism might be primarily prevented by detecting and
treating SDB in women prior to conception, and in infants shortly after birth.
Correspondence: Dr. Deborah E. Wardly, 7901 Autumn Gate Avenue, Las Vegas, NV
89131, USA. PHONE: 916-712-0704. FAX: 505-212-1712.