Circadian Rhythms in Acute Respiratory Distress Syndrome: Molecular Mechanisms and Therapeutic Implications.

Acute respiratory distress syndrome (ARDS) is a high-mortality condition lacking targeted treatments. Emerging evidence indicates that circadian rhythm disruption is a key factor in the development of ARDS. Core clock proteins control essential processes, including alveolar-capillary barrier function, inflammation, and tissue repair. The intensive care unit (ICU) environment and underlying illness create double hits that impair biological clocks, leading to a cycle of excessive inflammation and organ damage. This review highlights the central role of circadian rhythms in ARDS. Despite strong preclinical evidence, there are still many challenges for clinical application, including a lack of high-quality human studies and uncertainty about the optimal timing of interventions. Incorporating biological rhythm stabilization into multimodal ARDS management is a prerequisite step toward precision medicine. Future research should focus on mechanistic and translational studies to confirm the safety and effectiveness of chronomedicine in improving long-term patient outcomes.