Posted by Alamo Joe on September 14, 2008 at 18:59:21:Three sources of autism
This work presents my analysis of regressive autism, autism caused during birthing and autism caused by events during pregnancy. Regressive, birthing process and pregnancy autism are presented in sequence. I am not a doctor.
Regressive autism
This group of etiologies for the mental and physical components of regressive autism is an update/improved organization of earlier work. The original impetus for this work came from the combination of: 1) Wakefield’s paper on colitis, vaccinations and autism and 2) Internet anecdotal reports that treating sleep apnea also treated ulcerative colitis, reflux and irritable bowel syndrome. The etiologies reflect the conclusion that sleep apnea underlies both physical and mental aspects of regressive autism.
Some sleep apnea information to facilitate understanding is followed by the four events in the etiology of sleep apnea. These four events are the first four of the five events in the etiologies of brain injury, colitis, gout (high levels of uric acid), diabetes, reflux and ear infections.
Sleep background
When we sleep we relax. The deeper the sleep the greater the muscle relaxation. Both the airway dilation muscles and respiratory drive muscles are affected.To avoid apneas the pressure difference between the tip of the nose and the interior of the lung must be sufficient to overcome airway resistance to air flow and the tendency of the airway to collapse.
Specific etiology of OSA for the regressive autism epidemic.
1) The child is bottle fed predisposing it to obstructive sleep apnea.
(The difference in the forces used by bottle fed infants when compared to breast fed infants leads to a high palate in the bottle fed infant. The elevated palate results in an elevated floor of the nasal passages narrowing the airway thus increasing airway resistance.[1]) A paper by Rigas states that the severity of Crohn’s disease and colitis is related to the duration of bottle feeding[2] reinforces the possible role of bottle feeding in autism.
2) The child is exposed to MMR or DpT which causes nasal congestion. (Upper respiratory viral infections can cause nasal congestion.[3]) (Components of MMR and DpT contain upper respiratory viral infections. Exposure to MMR and DpT is mandated.)
3) The nasal congestion initiates or causes obstructive sleep apnea.[3] (As evidence that DpT is involved, hospital staff monitor infants after DpT vaccinations to facilitate treatment when apneas are detected.[4])
4) (a) The reduced levels of oxygen due to apneas adversely affects the brain. (b) During apneas the diaphragm makes multiple attempts at 10 to 15 times greater than normal effort in an attempt to overcome the airway obstruction.[5] (c) The force of the diaphragm is transmitted to the lower esophageal sphincter. (d) At the end of an apnea the diaphragm relaxes and returns to an inverted cup shape. This relaxation causes a rapid expulsion of air which sounds like a ‘snort’. (e) Apneas interrupt the normal sleep cycle.Disorders caused by OSA
OSA causes both mental and physical problems. Etiology Step 4 immediately above identifies the aspects of OSA which cause the disorders. Thus the first four steps in the etiology of OSA are also the first four steps in of each of the ailments. 4a) The low oxygen levels injure the brain, while 4b) “blunt force trauma, injures the intestines and kidneys, organs in proximity to the diaphragm. 4c) Reflux is caused by the physical connection between the lower esophageal sphincter and the diaphragm which opens the sphincter. 4d) The apnea termination ‘snort’ insufflates infectious organisms into the middle ear resulting in ear infections. 4e) Interruption of the normal sleep cycle causes daytime sleepiness.Note: Although infections are a factor in the etiology of OSA, the aspects of OSA (Etiology step 4), which are the immediate causes of the ailments associated with regressive autism, are mechanical in nature and they have no direct relation to the immune system.
The relation of OSA to the mental problems, colitis, high levels of uric acid, reflux, ear infections and sleep problems will be discussed in order.
OSA and Brain Damage {Step 5} (including cognitive/executive abilities) etiology
For OSA to be a factor in autism, OSA must be capable of causing brain damage. Hypoxia, caused by OSA,[5] may cause brain damage by depriving the brain of sufficient oxygen to function normally.[6,7] Lower than normal oxygen levels can reduce cognitive ability at oxygen levels which are just below normal value.[8] “Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex.”[9]Children with OSA have less ability to perform tasks in which decisions were required and have lower IQ.[9] A relation between OSA and cognition is suggested by reports of improvements in cognition following treatment for OSA.[10-12]
Colitis etiology {Step 5}
In step 4b of OSA etiology the ‘blunt force trauma’ inflicted upon the intestines during apneas causes the “gut inflammation” of colitis. The trauma to the intestines causes them to malfunction. It is surmised that the trauma inflicted by the diaphragm is analogous to the handling of the intestines by the surgeon during abdominal surgery. Of course one does not have surgery every day, but one hopes to sleep every night.“The severity of Crohn’s and colitis is related to the duration of bottle feeding” [2] is consistent with bottle feeding causing OSA and colitis.
An NIH web page reports that although the cause of colitis is unknown, respiratory infections can initiate an attack of colitis.[13] Mandated MMR and DpT vaccines contain components capable of causing respiratory infections, therefore this NIH reference indicates that vaccines, by causing an exacerbation of breathing problems, could also cause colitis and colitis attacks.
The information in the two paragraphs immediately above imply prevention of autism and prevention of colitis are identical: “Breast feeding and avoiding vaccines containing components which can cause upper respiratory viral infections provides protection against colitis and autism.
Entities other than MMR and DpT can also cause nasal congestion.[3] However, only exposure to MMR and DpT is mandated.
High levels of uric acid etiology {Step 5}
About one fifth of autistic children have high levels of uric acid.[14] The literature report that uric acid levels in OSA patients were normalized by treatment with continuous positive airway pressure (CPAP), a treatment for OSA,[15] and levels of uric acid are related to the severity of OSA[16] strongly suggest that OSA is the cause of high levels of uric acid. It appears that the ‘blunt force trauma’ also affects the kidneys. The patient profile for gout is “older overweight men and women after menopause”, the same as the profile for OSA implying an environmental change is involved. The children are neither “older overweight men nor women after menopause”.Diabetes etiology {Step 5}
The literature suggests that diabetes is secondary to OSA: 1) The prevalence of diabetes is directly related to levels of sleep disordered breathing,[17] 2) Sleep apnoea treatment reduces the severity of diabetes,[18] 3) OSA is independently associated with insulin resistance,[19,20] 4) Sleep disordered breathing is also associated with glucose intolerance.[20]The diaphragm is surmised to inflict ‘blunt force trauma’ to the pancreas, injuring it and causing diabetes.
Again, bottle feeding is a risk. It is a risk for diabetes.[21]
Reflux etiology {Step 5}
Reflux is caused when the repeated attempts to induce normal inspiration during a respiratory event results in increased effort by the diaphragm. This effort is linked by the phrenoesophageal ligament to the lower esophageal sphincter which is pulled open permitting the gastric juices to be refluxed into the nasopharynx.[22]Ear infections etiology {Step 5}
Digestive products have been found in the middle ear.[23] Products of digestion have been refluxed into the nasopharynx.[22] In 4)d, the ‘snort’ which opens the eustachian tube also insufflates infectious organisms into the middle ear resulting in ear infections.[24] The finding of digestive products in the middle ear supports the concept of the insufflation of infectious organisms into the middle ear.Again, bottle feeding is a risk. This time it is risk for ear infections. Exclusive breast-feeding for at least 4 months protects against otitis media.[25]
Sleep problems etiology {Step 5}
In 4)e, the apneas interrupt sleep at night. Sleep is fragmented by apneas which can occur over 80 times an hour. Daytime sleepiness is not unusual.Genetic factors (?)
The high ratio of autism in families and in siblings has been interpreted to indicate that genes are involved in autism. Human nature might be a confounding factor in that interpretation. The primiparous woman usually requests guidance on the method of infant nutrition from her husband or her mother.[26]The apparent high prevalence of autism in siblings may be due to the tendency to bottle feed a child born into a family with a developmentally disabled child.[27]
Some papers, based on concordance of autism in identical twins when compared to concordance in fraternal twins, concluded that autism could be a genetic disorder. One paper recognizes that “ … competition for nutrients …” or the number of ova involved might be confounding elements.[28] Other literature rejects the twin genetic defect conclusion.[29]
4 to 1 Gender ratio
I suspect that the 4:1 ratio is due to the girls fluctuating hormones. Premenstrual syndrome[32] and irritable bowel syndrome[33] due to changing severity of sleep apnea in different portions of the menstrual cycle.Environmental changes
Bottle feeding instead of breast feeding is about as extreme an environmental change as there can be. Another environmental change, vaccinations, have been useful in the past, but in regressive autism they seem to be elements in its etiology. It is surmised that bottle feeding instead of breast feeding is the reason “Older overweight men and women after menopause” is no longer a valid patient profile for either gout and OSA patients.Bottle feeding and etiologies
This the first time etiologies involving bottle feeding have been presented in totality. Possibly additional ‘bottle feeding’ related disorders are also secondary to obstructive sleep apnea.Mechanical aspects
The forces used in feeding, the change in skull shape and the aspects of Step 4 are all mechanical suggesting that antibodies are not involved in protecting the individual from various ailments.Treating OSA
OSA can be treated by weight loss, positional sleeping, surgery, CPAP and exercises to strengthen the diaphragm. Each treatment has its disadvantage.Weight loss is a chore while positional sleeping can lead to aches and pains due to prolonged pressures on portions of the body.
Along with the risks of surgery, surgery may require more than one surgery to sculpt a viable airway. Additionally, orthodontic treatment might be needed following jaw advancement surgery.
CPAP increases the pressure difference between the tip of the nose and the interior of the lung. The increased pressure difference tends to prevent the airway from collapsing. Successful use requires that the person tolerate the system. Traveling with CPAP equipment sometimes is a problem. In young children the mask may cause facial flattening.[30]
Strengthening the diaphragm lowers the air pressure within the lungs, thus increasing the pressure difference between the tip of the nose and the interior of the lung. Inhaling and exhaling through pursed lips or playing the didgeridoo[31] can strengthen the airway and/or the diaphragm. The pressure within the lung can not be lowered without limit.
OSA treatment and physical manifestations of regressive autism
The anecdotal reports that treating OSA also treated colitis and the mechanical aspects of Etiology Step 4 suggests that all the physical manifestations of OSA can be treated by treating OSA.OSA treatment and mental problems of regressive autism
Above, insufficient oxygen (Hypoxia) has been suggested as the cause of regressive autism brain injury. Will supplying ‘replacement’ oxygen (hyperbaric) do any good?References for regressive autism
1. Palmer B. Breast-feeding: Reducing the risk for obstructive sleep apnea. Breast-feeding Abstracts, 1999 February; 18(3):19-20.2. Rigas A, Rigas B, Glassman M, Yen YY, Lan SJ, Petridou E, Hsieh CC, Trichopoulos D. Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood. Ann Epidemiol. 1993 Jul;3(4):387-92.
3. Corey JP, Houser SM, Ng BA. Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J. 2000 Sep;79(9):690-3, 696, 698 passim.
4. Lee J, Robinson JL, Spady DW. Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants. BMC Pediatr. 2006 Jun 19;6:20.
5. Guilleminault, C (1985) Obstructive sleep apnea: the clinical syndrome and historical perspective. Med Clin North Am 69,1187-1203
6. http://www.ninds.nih.gov/disorders/anoxia/anoxia.htm
Accessed 3/8/20087. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, Fanaroff AA, Poole WK, Wright LL, Higgins RD, Finer NN, Carlo WA, Duara S, Oh W, Cotten CM, Stevenson DK, Stoll BJ, Lemons JA, Guillet R, Jobe AH; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005 Oct 13;353(15):1574-84. [abstract]
8. Bass JL, Corwin M, Gozal D, Moore C, Nishida H, Parker S, Schonwald A, Wilker RE, Stehle S, Kinane TB. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics. 2004 Sep;114(3):805-16.
9. Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL, Smith PL, Prahme MC, Mahone EM. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med. 2006 Aug;3(8):e301
10. Engleman HM, Kingshott RN, Martin SE, Douglas NJ. Cognitive function in the sleep apnea/hypopnea syndrome (SAHS). Sleep. 2000 Jun 15;23 Suppl 4:S102-8.
11. Friedman BC, Hendeles-Amitai A, Kozminsky E, Leiberman A, Friger M, Tarasiuk A, Tal A. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep. 2003 Dec 15;26(8):999-1005. [abstract]
12. Stewart MG, Glaze DG, Friedman EM, Smith EO, Bautista M. Quality of life and sleep study findings after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2005 Apr;131(4):308-14.
13. http://www.nlm.nih.gov/medlineplus/ency/article/000250.htm
Accessed 5/1/200814. Page T, Coleman M. Purine metabolism abnormalities in a hyperuricosuric subclass of autism. Biochim Biophys Acta. 2000 Mar 17;1500(3):291-6.
15. Sahebjani H. Changes in urinary uric acid excretion in obstructive sleep apnea before and after therapy with nasal continuous positive airway pressure. Chest. 1998 Jun;113(6):1604-8.
16. Schafer H, Pauleit D, Sudhop T, Gouni-Berthold I, Ewig S, Berthold HK. Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea. Chest. 2002 Sep;122(3):829-39.
17 Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1590-5. Epub 2005 Sep 28.
18. Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005 Feb 28;165(4):447-52.
19. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002 Mar 1;165(5):670-6.
20. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002 Mar 1;165(5):677-82
21. Virtanen SM, Rasanen L, Aro A, Ylonen K, Lounamaa R, Tuomilehto J, Akerblom HK. Feeding in infancy and the risk of type 1 diabetes mellitus in Finnish children. The 'Childhood Diabetes in Finland' Study Group. Diabet Med. 1992 Nov;9(9):815-9. [abstract]
22. Herr J. Chronic cough, sleep apnea, and gastroesophageal reflux disease. Chest. 2001 Sep;120(3):1036-7.
23. Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, Pearson JP. Reflux of gastric juice and glue ear in children. Lancet. 2002 Feb 9;359(9305):493.
24. Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast-feeding for at least 4 months protects against otitis media.Pediatrics. 1993 May;91(5):867-72. [abstract]
25. Herr JR. Re: Autism--ear infections--glue ear--sleep disorders. J Autism Dev Disord. 2003 Oct;33(5):557.
26. LeFevre M, Kruse J, Zweig S. Selection of infant feeding method: a population-based study in a rural area. J Fam Pract. 1987 May;24(5):487-91. [abstract]
27 Burd L, Fisher W, Kerbeshian J, Vesely B, Durgin B, Reep P. A comparison of breastfeeding rates among children with pervasive developmental disorder, and controls. J Dev Behav Pediatr. 1988 Oct;9(5):247-51.
28. Greenberg DA, Hodge SE, Sowinski J, Nicoll D. Excess of twins among affected sibling pairs with autism: implications for the etiology of autism. Am J Hum Genet. 2001 Nov;69(5):1062-7. Epub 2001 Oct 2.
29. Hultman CM, Sparén P, Cnattingius S. Perinatal risk factors for infantile autism. Epidemiology. 2002 Jul;13(4):417-23.
30. Fauroux B, Lavis JF, Nicot F, Picard A, Boelle PY, Clement A, Vazquez MP. Facial side effects during noninvasive positive pressure ventilation in children. Intensive Care Med. 2005 Jul;31(7):965-9.
31. Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006 Feb 4;332(7536):266-70. Epub 2005 Dec 23
32. Herr JR. Is sleep disorder treatment appropriate for premenstrual syndrome? Acta Obstet Gynecol Scand. 2003 Jan;82(1):99.
33. Herr JR. Medical literature implies continuous positive airway pressure might be appropriate treatment for irritable bowel syndrome. Chest. 2002 Sep;122(3):1107.
End of Regressive Autism
Autism (Not regressive)Some autistic children present seem to have autism at birth. The literature implies that children autistic ‘at birth’ may be affected during the birthing process or are affected during gestation.
Autism due to birthing problems
Researchers studying autism in twins suggests that an environmental factor underlying autism could be brain injury caused by 6 minutes or more of perinatal apnea or delayed birth of 30 minutes,[1] In addition autim at birth can be caused by breech presentation, delivery before 35 weeks, and low birth weight at delivery. This suggests that lack of oxygen is involved. Reduced levels of oxygen is a characteristic of obstructive sleep apnea. It seems that obstructive sleep apnea underlies birth autism.
Reference for Birthing Process Autism
1. 1. Folstein S, Rutter M. Genetic influences and infantile autism. Nature. 1977 Feb 24;265(5596):726-8.End of Birthing Process Autism
Autism due to pregnancy factorsObstructive sleep apnea background (Pregnancy)
An apnea can develop if the pressure difference between the tip of the nose and the interior of the lung is insufficient to overcome airway resistance and the tendency of the airway to collapse. One factor in the pressure difference is the excursion of the diaphragm. The diaphragm, while its excursion would normally be directly related to the magnitude of respiratory drive, may have its excursion limited by the bulk of the fetus. Primarily, this would occur in the last trimester of pregnancy.Prenatal brain injury (Gestational obstructive sleep apnea)
Circumstances 1 through 3 below examples of various conditions which can result in gestational obstructive sleep apnea. Transient fetal hypoxia can have an adverse effect on the fetus.[1]Circumstance # 1
Transient fetal hypoxia may have an adverse effect on the fetus.[1] During pregnancy OSA may be initiated in the mother or become exacerbated.[2-4] The symptoms associated with OSA increase during pregnancy.[2]During the third trimester of pregnancy The bulk of the fetus may reduce the effective respiratory drive by limiting the diaphragm’s excursion. sufficiently to initiate OSA. If the mother‘s airway has been compromised by bottle feeding the likelihood of the mother developing OSA is increased.
Circumstance # 2
It is postulated that the etiology of autism secondary to ‘in utero rubella’ is: 1) The mother may have a compromised respiratory system, 2) Nasal congestion develops as the result of rubella, 3) The nasal congestion causes OSA[5] and 4) OSA induced hypoxia injures the fetal brain.The immediately above describes OSA caused by rubella. Others have described autism as the result of congenital cytomegalovirus.[6] It is postulated that cytomegalovirus induces OSA by the same etiology as rubella and the reduced levels of oxygen again results in fetal brain damage.
Circumstance # 3
Fetal alcohol syndrome is caused by a pregnant woman consuming alcoholic beverages. In this case, the respiratory drive muscles necessary to avoid apneas relax under the influence of alcohol. The resulting apneas reduce the oxygen available to the fetus resulting brain damage.Discussion
The common factor in autism is the reduced levels of oxygen. Only the circumstances leading to low oxygen levels vary.
References for Autism due to pregnancy factors1. Pien GW, Fife D, Pack AI, Nkwuo JE, Schwab RJ. Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep. 2005 Oct 1;28(10):1299-305. [abstract]
2. Kowall J, Clark G, Nino-Murcia G, Powell N. Precipitation of obstructive sleep apnea during pregnancy. Obstet Gynecol. 1989 Sep;74(3 Pt 2):453-5.
3. Roush SF, Bell L. Obstructive sleep apnea in pregnancy. J Am Board Fam Pract. 2004 Jul-Aug;17(4):292-4.
4. Joel-Cohen SJ, Schoenfeld A. Fetal response to periodic sleep apnea: a new syndrome in obstetrics. Eur J Obstet Gynecol Reprod Biol. 1978 Apr;8(2):77-81. [abstract]
5. Corey JP, Houser SM, Ng BA. Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J. 2000 Sep;79(9):690-3, 696, 698 passim
6. Yama----a Y, Fujimoto C, Nakajima E, Isagai T, Matsuishi T. Possible association between congenital cytomegalovirus infection and autistic disorder. J Autism Dev Disord. 2003 Aug;33(4):455-9. [abstract]
Best to all
CA Alamo Joe
End of paper