Background:
Intrinsic variance of the urine proteome limits the discriminative power of proteomic analysis and complicates potential biomarker detection in the context of pediatric sleep disorders.
Methods and Results:
Using a rigorous workflow for proteomic analysis of urine, we demonstrate that gender and diurnal effects constitute two important sources of variability in healthy children. In the context of disease, complex pathophysiological perturbations magnify these proteomic differences and therefore require contextualized biomarker analysis. Indeed, by performing biomarker discovery in a gender and diurnal-dependent manner, we identified ~30-fold more candidate biomarkers of pediatric obstructive sleep apnea (OSA), a highly prevalent condition in children characterized by repetitive episodes of intermittent hypoxia and hypercapnia, and sleep fragmentation in the context of recurrent upper airway obstructive events during sleep. Remarkably, biomarkers were highly specific for gender and sampling time since poor overlap (~3%) was observed in the proteins identified in boys and girls across morning and bedtime samples.
Conclusions:
Since no clinical basis to explain gender-specific effects in OSA or healthy children is apparent, we propose that implementation of contextualized biomarker strategies will be applicable to a broad range of human diseases, and may be specifically applicable to pediatric OSA.