Night Sweats: A Systematic Review of the Literature

Abstract

Background: Much of primary care involves helping patients manage symptoms. Nighttime sweating is a symptom linked to menopause, malignancies, autoimmune diseases, and infections. However, in primary care settings, night sweats are commonly reported by persons without these conditions.Methods: We conducted a literature review, focusing on questions about definition, mechanisms, incidence/prevalence, measurement, clinical causes, evaluation, treatment, and prognosis. We limited our search to English language studies of adult humans published since 1966. Because studies of estrogen and androgen deficiency states had been reviewed by others, we excluded them. Search criteria were developed for each question. Publications meeting criteria were reviewed by the first 2 authors and consensus was reached through discussion.Results: Prevalence estimates ranged from 10% among older primary care patients to 60% among women on an obstetrics inpatient unit. Life expectancy of primary care patients reporting night sweats did not appear to be reduced. Although many clinical causes have been suggested, most are not well supported. Algorithmic approaches to evaluation are not evidence-based. Alpha adrenergic blockers may reduce night sweats in patients taking serotonin reuptake inhibitors. Thalidomide and thioridazine may benefit some terminal cancer patients with night sweats.

Physiology of sweat gland function: The roles of sweating and sweat composition in human health

“…Increased sweating with generalized or unilateral distribution as a result of underlying physiologic condition (fever, pregnancy, menopause), pathology (malignancy, infection, cardiovascular disease, endocrine/metabolic, neurological or psychiatric disorders), or medication [3,[356][357][358][359]. Limited data on sweat composition.…”

“…anticholinergics and tricyclic antidepressants) [346,355]. Hyperhidrosis, where sweating occurs in excess of thermoregulatory demands, can occur with primary etiology [3,29] or secondary to physiologic condition (fever, pregnancy, menopause), pathology (malignancy, endocrine, metabolic, or psychiatric disorder), or medication (cholinesterase inhibitors, SSRIs, opioids) [3,[356][357][358][359]. However, these types of hypo-and hyperhidrosis are often localized and/or episodic and the impact on whole-body thermoregulation and/or fluid balance during exercise and/or heat stress is not well-studied.…”

Connecting the Dots: Could Microbial Translocation Explain Commonly Reported Symptoms in HIV Disease?

“…Among these symptoms, functional decline (Erlandson et al, 2013; Stehle et al, 2012), cognitive decline (Ancuta et al, 2008; Kamat, Lyons, et al, 2012), obesity (Koethe et al, 2013), anxiety, and sadness (Liebregts et al, 2007) have been associated with microbial translocation, indicated by elevated levels of sCD14 and/or Gram-negative bacterial LPS along with other inflammatory cytokines. Fatigue (Klimas, Broderick, & Fletcher, 2012), muscle aches, joint pain (Eriksson, Andersson, Ekerfelt, Ernerudh, & Skogh, 2004), poor sleep (Grandner, Sands-Lincoln, Pak, & Garland, 2013), fever/chills/sweats (Holtzclaw, 2013), night sweats (Mold, Holtzclaw, & McCarthy, 2012), peripheral neuropathy (Harezlak et al, 2011; Zheng et al, 2011), diarrhea (Liebregts et al, 2007), anxiety, depression (Camacho, 2013), and weight loss/wasting (Stein et al, 1997) have been associated with chronic inflammation as indicated by the elevation of proinflammatory cytokines. Table 2 provides a list of HIV-associated symptoms consistently reported by PLWH and displays the gaps in knowledge in regard to whether each has been associated with inflammation.…”

Dronabinol for the Treatment of Paraneoplastic Night Sweats in Cancer Patients: A Report of Five Cases

“…These night sweats result in physical and emotional fatigue, depression, and reduced function, promoting a vicious cycle associated with the anorexia-cachexia syndrome that often afflicts cancer patients. [1][2][3][4] Hot flashes affect 50-85% of menopausal women, 5 with an incidence of 65-85% in breast cancer patients due to antiestrogen therapies. 6 An association between night sweats and sleep disruptions, including awakenings for pain, has been reported in male patients.…”

“…6 An association between night sweats and sleep disruptions, including awakenings for pain, has been reported in male patients. 2 Studies indicate the prevalence of night sweats in the paraneoplastic population ranges from 10% to 48%, 1,7 presenting a major challenge in the symptomatic treatment of this group.…”