Detection and Analysis of Circadian Biomarkers for Metabolic Syndrome Using Wearable Data: Cross-Sectional Study

Abstract

Abstract BackgroundWearable devices are increasingly used for monitoring health and detecting digital biomarkers related to chronic diseases such as metabolic syndrome (MetS). Although circadian rhythm disturbances are known to contribute to MetS, few studies have explored wearable-derived circadian biomarkers for MetS identification. ObjectiveThis study aimed to detect and analyze sleep and circadian rhythm biomarkers associated with MetS using step count and heart rate data from wearable devices and to identify the key biomarkers using explainable artificial intelligence (XAI). MethodsData were analyzed from 272 participants in the Korean Medicine Daejeon Citizen Cohort, collected between 2020 and 2023, including 88 participants with MetS and 184 without any MetS diagnostic criteria. Participants wore Fitbit Versa or Inspire 2 devices for at least 5 weekdays, providing minute-level heart rate, step count, and sleep data. A total of 26 indicators were derived, including sleep markers (midsleep time and total sleep time) and circadian rhythm markers (midline estimating statistic of rhythm, amplitude, interdaily stability, and relative amplitude). In addition, a novel circadian rhythm marker, continuous wavelet circadian rhythm energy (CCE), was proposed using continuous wavelet transform of heart rate signals. Statistical tests (t ResultsCircadian rhythm markers, especially heart rate–based indicators, showed stronger associations with MetS than sleep markers. The newly proposed CCE demonstrated the highest importance for MetS identification across all XAI models, with significantly lower values observed in the MetS group (P ConclusionsThis study identified CCE and relative amplitude of heart rate as key circadian rhythm biomarkers for MetS monitoring, demonstrating their high importance across multiple XAI models. In contrast, traditional sleep markers showed limited significance, suggesting that circadian rhythm analysis may offer additional insights into MetS beyond sleep-related indicators. These findings highlight the potential of wearable-based circadian biomarkers for improving MetS assessment and management.