Persistent Night Sweats: Diagnostic Evaluation

 

Night sweats are a nonspecific symptom that patients commonly experience but rarely discuss with their physicians without prompting. Although many life-threatening causes such as malignancies or infections have been described, most patients who report persistent night sweats in the primary care setting do not have a serious underlying disorder. Conditions commonly associated with night sweats include menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity. If a clinical diagnosis is apparent based on the initial history and physical examination, specific treatment for four to eight weeks may be offered. When the history and physical examination do not reveal a specific cause, physicians should proceed with a systematic and cost-conscious strategy that uses readily available laboratory and imaging studies, such as a complete blood count, tuberculosis testing, thyroid-stimulating hormone levels, HIV testing, C-reactive protein level, and chest radiography. Additional tests that could be considered selectively include computed tomography of the chest and/or abdomen, bone marrow biopsy, polysomnography, and/or additional laboratory studies if indicated. If these results are normal, and no additional disorders are suspected, reassurance and continued monitoring are recommended. The presence of night sweats alone does not indicate an increased risk of death.

Night sweats are a common experience, with a prevalence of up to 41% among primary care patients.1 The definition of night sweats varies and generally does not require that the symptom be bothersome to the patient.2 One definition suggested in a 2010 study was “sweating at night even when it is not excessively hot in your bedroom.”3 New evidence from the primary care setting has been published since the last American Family Physician review of this topic.4

WHAT'S NEW ON THIS TOPIC

Night Sweats

A systematic review found that the cross-sectional prevalence of night sweats ranges from 10% to 41% in the primary care setting, with the highest prevalence occurring in patients between 41 and 55 years of age.

In a study of school-aged children in China, 12% reported having weekly night sweats during the past year. When present, night sweats were associated with obstructive sleep apnea, insomnia, anxiety, and respiratory and atopic symptoms.

A cohort study of 1,534 patients older than 65 years found that after seven years, patients who reported having night sweats were not more likely to die or to die earlier than patients who did not report them.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

For patients without signs or symptoms and a specific clinical diagnosis, treat the assumed condition empirically for four to eight weeks and reevaluate symptoms.4,11

C

Usual practice, case series, and expert opinion

Identify patients at high risk of infection or malignancy by the presence of findings such as weight loss, objective fever, or lymphadenopathy.2,18

C

Usual practice, case series, case reports, and expert opinion

Reassure and clinically monitor patients who complete a basic evaluation and are unlikely to have a serious underlying cause of their night sweats.14

C

Limited epidemiologic data, expert opinion, and usual practice


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

For patients without signs or symptoms and a specific clinical diagnosis, treat the assumed condition empirically for four to eight weeks and reevaluate symptoms.4,11

C

Usual practice, case series, and expert opinion

Identify patients at high risk of infection or malignancy by the presence of findings such as weight loss, objective fever, or lymphadenopathy.2,18

C

Usual practice, case series, case reports, and expert opinion

Reassure and clinically monitor patients who complete a basic evaluation and are unlikely to have a serious underlying cause of their night sweats.14

C

Limited epidemiologic data, expert opinion, and usual practice


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Author

CARL BRYCE, MD, is a faculty physician at the Abrazo Family Medicine Residency Program, Phoenix, Ariz. At the time this article was written, he was associate program director of the Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, Neb., and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.

Address correspondence to Carl Bryce, MD, Abrazo Family Medicine Residency, 2000 W. Bethany Home Rd., Ste. 200, Phoenix, AZ 85015 (email: carl.bryce@abrazohealth.com). Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Mold JW, Mathew MK, Belgore S, et al. Prevalence of night sweats in primary care patients: an OKPRN and TAFP-Net collaborative study. J Fam Pract. 2002;51(5):452–456....

2. Mold JW, Holtzclaw BJ, McCarthy L. Night sweats: a systematic review of the literature. J Am Board Fam Med. 2012;25(6):878–893.

3. Mold JW, Lawler F. The prognostic implications of night sweats in two cohorts of older patients. J Am Board Fam Med. 2010;23(1):97–103.

4. Viera AJ, Bond MM, Yates SW. Diagnosing night sweats. Am Fam Physician. 2003;67(5):1019–1024. Accessed September 18, 2019. https://www.aafp.org/afp/2003/0301/p1019.html

5. So HK, Li AM, Au CT, et al. Night sweats in children: prevalence and associated factors. Arch Dis Child. 2012;97(5):470–473.

6. Dandona P, Rosenberg MT. A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract. 2010;64(6):682–696.

7. Chambers ST, Murdoch D, Morris A, et al.; International Collaboration on Endocarditis Prospective Cohort Study Investigators. HACEK infective endocarditis: characteristics and outcomes from a large, multinational cohort. PLoS One. 2013;8(5):e63181.

8. Bartoloni A, Zammarchi L. Clinical aspects of uncomplicated and severe malaria. Mediterr J Hematol Infect Dis. 2012;4(1):e2012026.

9. Herber-Gast GM, Mishra GD, van der Schouw YT, et al. Risk factors for night sweats and hot flushes in midlife: results from a prospective cohort study. Menopause. 2013;20(9):953–959.

10. Mold JW, Roberts M, Aboshady HM. Prevalence and predictors of night sweats, day sweats, and hot flashes in older primary care patients: an OKPRN study. Ann Fam Med. 2004;2(5):391–397.

11. Reynolds WA. Are night sweats a sign of esophageal reflux? J Clin Gastroenterol. 1989;11(5):590–591.

12. Mold JW, Woolley JH, Nagykaldi Z. Associations between night sweats and other sleep disturbances: an OKPRN study. Ann Fam Med. 2006;4(5):423–426.

13. Morales J, Schneider D. Hypoglycemia. Am J Med. 2014;127(10 suppl):S17–S24.

14. Mold JW, Goodrich S, Orr W. Associations between subjective night sweats and sleep study findings. J Am Board Fam Med. 2008;21(2):96–100.

15. Arnardottir ES, Janson C, Bjornsdottir E, et al. Nocturnal sweating—a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort. BMJ Open. 2013;3(5):e002795.

16. Herber-Gast GM, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013;97(5):1092–1099.

17. Grigoropoulos NF, Petter R, Van 't Veer MB, et al. Leukaemia update. Part 1: diagnosis and management. BMJ. 2013;346:f1660.

18. Mold JW, Holtzclaw BJ. Selective serotonin reuptake inhibitors and night sweats in a primary care population. Drugs Real World Outcomes. 2015;2(1):29–33.

19. Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol. 2002;55(7):481–486.

20. Gaddey HL, Holder K. Unintentional weight loss in older adults. Am Fam Physician. 2014;89(9):718–722. https://www.aafp.org/afp/2014/0501/p718.html

21. Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician. 2016;94(11):896–903. https://www.aafp.org/afp/2016/1201/p896.html

22. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–276.

 

 

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