Abstract
PURPOSE: To investigate the association between Circadian Syndrome (CircS)-a metabolic syndrome extension incorporating circadian disruption-and periodontitis in U.S. adults, and to identify high-risk subgroups for targeted prevention. METHODS: We analyzed 5,343 U.S. adults from NHANES 2009-2014. Periodontitis was defined by probing depth and clinical attachment level; CircS required ≥ 4 of 7 components (waist circumference, triglycerides, HDL-C, BP, fasting glucose, sleep ≤ 6 h, PHQ-9 ≥ 5). Weighted multivariable logistic regression, subgroup analyses and Propensity Score Matching (PSM) were used. RESULTS: CircS prevalence was 59.8%. After adjusting for sociodemographics and lifestyle, CircS was associated with 29% higher odds of periodontitis (OR = 1.29, 95%CI:1.08-1.53). Subgroups with elevated risk included females (OR = 1.499), non-Hispanic Whites (OR = 1.352), unmarried individuals (OR = 1.367), non-smokers (OR = 1.308), and those with low education (OR = 1.880). PSM sensitivity analysis confirmed robustness (OR = 1.22, p = 0.048). CONCLUSION: CircS independently predicts periodontitis risk, underscoring circadian-metabolic dysregulation as a shared pathway for oral-systemic disease. Integration of circadian health screening into diabetes/metabolic care may enhance periodontitis prevention, particularly in high-risk subgroups.