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Review ArticleClinical Review

Night Sweats: A Systematic Review of the Literature

James W. Mold, Barbara J. Holtzclaw and Laine McCarthy
The Journal of the American Board of Family Medicine November 2012, 25 (6) 878-893; DOI: https://doi.org/10.3122/jabfm.2012.06.120033
James W. Mold
the College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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Barbara J. Holtzclaw
the College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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Laine McCarthy
the College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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Article Figures & Data

Tables

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    Table 1. Published Definitions of Night Sweats
    Authors/YearPurposeDefinition
    Lister et al, 198947Clinical and research“Recurrent drenching night sweats during the previous month”
    Smetana, 199353Clinical“Drenching sweats that require changing bed clothes”
    Holtzclaw, 199654Clinical“A nonspecific term that refers to heavy sweating during sleep”
    Chambliss, 199944Clinical“Unusual sweating that occurs only or mainly at night”
    Mold et al, 200838Clinical“Sweating excessively during the night during the past month”
    Mold et al, 200237Research“Sweating at night even when it is not excessively hot in your bedroom during the past month”
    Lea and Aber, 198555ResearchMild: “no bathing or change of clothing required”
    Moderate: “sleep disturbed by need to arise and wash face or other affected body areas, but no clothing change”
    Severe: “both or clothing change required”
    Quigley and Baines, 199756ResearchMild: “no change in bedclothes necessary; sweating only reported after specific questioning”
    Moderate: “no change of clothing necessary; washing of affected areas required; sweating volunteered by patients as a specific problem”
    Severe: “volunteered by patients as drenching sweats requiring a change of clothing or bed linen or both”
    • View popup
    Table 2. Incidence and Prevalence of Night Sweats in Various Populations
    Authors/YearPopulation (Country)NPrevalence and Incidence Estimates
    Lea and Aber, 198555Hospital inpatients (US)174Prevalence: medicine: 33%
    Surgery: 33%
    Obstetrics: 60%
    Gynecology: 27%
    Reynolds, 198957Consecutive patients seen in a gastroenterology practice*200Prevalence: 41%
    Quigley and Baines, 199756Hospice inpatients patients, consecutive admissions (UK)100Prevalence: 16% overall
    12% soaked bed clothes
    Mold et al, 200237Primary care patients, consecutive visits (US)2267Prevalence: all: 41%
    Nighttime only: 23%
    4–7 nights per week: 16%
    Mold et al, 200440Primary care patients >65 years of age, recruited from billing records (US)795Prevalence: 10%
    Mold et al, 200639Primary care patients, consecutive visits (US)363Prevalence: 34%
    17% soaked bed clothes
    Mold et al, 200838Consecutive patients undergoing polysomnography (US)282Prevalence: 28%
    Mold and Lawler, 201046Consecutive patients >65 years of age enrolled in a primary care geriatric continuity clinic (US)*682Prevalence: 14% past year
    Mold and Lawler, 201046Primary care patients >65 years of age, recruited from billing records (US)795Incidence (annual): 5%
    Suwanprathes et al, 201058Random population sample, (Bangkok, Thailand)*4680Prevalence: 4.4%
    • ↵* Night sweats definition not provided in report.

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    Table 3. Variables Associated with Night Sweats in Epidemiological Studies
    Authors/YearStudy DesignAnalytic MethodFactors Associated with Night Sweats
    Lea and Aber, 198555Cross-sectionalχ2Aspirin or acetaminophen use (P < 0.05)
    Mold et al, 200237Cross-sectionalLogistic regressionAll: panic attacks (OR, 4.8; 1.7–13.6)*
    Men: sleep problems (OR, 2.5; 1.7–3.8)
    Women: hot flashes (OR, 3.4; 1.1–10.0)
    Panic attacks (OR, 4.5; 1.2–16.7)
    Mold et al, 200440Cross-sectionalLogistic regressionAge (OR, 0.94/year; 0.89–0.98)
    Fever (OR, 12.6; 6.6–24.1)
    Numbness hands/feet (OR, 3.3; 1.9–5.8)
    Muscle cramps (OR, 2.8; 1.5–5.2)
    Impaired vision–subjective (OR, 2.5; 1.4–4.3)
    Cluster analysisImpaired hearing–subjective (OR, 1.8; 1.0–3.3)
    Symptoms of anxiety and stress (P = 0.001)
    Symptoms of dysphoria (P = 0.001)
    Pain and discomfort (P < 0.0001)
    Mold et al, 200639Cross-sectionalLogistic regressionDaytime tiredness (OR, 2.0; 1.1–3.5)
    Waking with bitter taste (OR, 1.9; 1.2–3.2)
    Awakening with pain (OR, 1.9; 1.2–3.0)
    Legs jerk in sleep (OR, 1.8; 1.1–3.0)
    Mold et al, 200838Cross-sectionalLogistic regressionTrouble breathing at night (OR, 2.8; 1.5–5.2)
    Awakened by aches and pains (OR, 3.2 (1.8–5.8)
    Epworth Sleepiness Scale (OR, 1.1 (1–1,1)
    • ↵* ORs with 95% CIs.

    • CI, confidence interval; OR, odds ratio.

    • View popup
    Table 4. Evidence Supporting Associations between Clinical Conditions and Elicited Subjective Night Sweats
    Clinical DisorderNComparative DataProportion with Night Sweats (if Comparison Group) or Proportion in Whom Night Sweats Resolved with Treatment
    AutoimmunePOEMS syndrome1NoDisorder treated, night sweats resolved59
    Rheumatoid arthritis1NoDisorder treated, night sweats resolved60
    Giant cell arteritis1NoDisorder treated, night sweats resolved61
    CardiovascularAortic dissection, chronic1NoDisorder treated, night sweats resolved62
    Nocturnal/Prinzmetal angina1NoDisorder treated, night sweats persisted63
    EndocrineDiabetes insipidus1NoDisorder treated/night sweats resolved64
    Hyperthyroidism1NoDisorder treated, night sweats resolved65
    GIGERD12NoDisorder treated, night sweats resolved (100%)57
    Infectious diseaseHIV
        P24 Ag+, HIV−3816Yes5/58 (9%)
        P24 Ag−, HIV−38/3758 (1%)66
        HIV-negative328Yes20/328 (6%) night sweats
        Acute HIV+59/328 (18%)
        Chronic HIV+39/328 (12%)67
        HIV seroconverters110Yes18/22 (82%) night sweats
        Nonseroconverters6/88 (7%)68
        IV drug users, HIV+223Yes33/124 (27%) night sweats
        IV drug users, HIV−13/99 (13%)69
        Hodgkin disease, HIV+16Yes2/5 (40%) night sweats
        Hodgkin disease, HIV−3/11 (27%)70
        HIV+ with persistent generalized lymphadenopathy88Yes12/38 (32%) night sweats
        HIV+ with lymphoma7/50 (14%)71
        TB patients, HIV+158Yes24/48 (50%)
        TB patients, HIV−11/31 (35%)72
        HIV patients, TB+899Yes15/44 (34%) night sweats
    108/855 (14%)73
        HIV patients, TB−31No27/31 (87%) 4.8 episodes per week pretreatment; 1.6 episodes/week posttreatment74
        HIV+, MAC25No21/25 (84%) had night sweats pretreatment;
    post treatment one of 25 (4%) had night sweats75
    24No18/24 (75%) had night sweats pretreatment;
    posttreatment 6/24 (25%) had night sweats76
    187No67/187 (36%) had night sweats pretreatment;
    posttreatment 40% had fewer night sweats when treated with 4 drugs;
    1748Yes70% had fewer when treated with 3 drugs77
        HIV+, TB+88/267 (33%) had HIV+ with TB+
        HIV+, TB−191/1471 (13%) had HIV+ without TB
        HIV+, TB+128/267 (48%) had night sweats past 24 hours
        HIV+, TB−368/1471 (25%)78 had night sweats past month
    Viral URI/Mononucleosis356YesCohort matched on age, sex, date of diagnosis; night sweats more common in mononucleosis (P = .000001)79
    Tuberculosis
        Hospitalized patients awaiting TB diagnosis (44 were TB-positive)101YesNo significant difference in rate of night sweats between those with TB and those without TB80
        Hospitalized patients in isolation awaiting diagnosis563Yes26/47 (55%) of TB patients reported night sweats; 141/516 (27%) of non-TB patients reported night sweats52,81
        Emergency department patients with sputum tested for TB145Yes13/28 (46%) with positive sputum reported night sweats; 29/113 (26%) with negative sputum reported night sweats51
        Hospitalized patients awaiting TB diagnosis101Yes44/100 were TB-positive; no association between reported night sweats and TB positivity80
    Cysticercosis (Coenurus)1NoCase history; night sweats and lymphoma-like symptoms ceased with excision of larval cysts82
    MedicationsAntidepressants
    Sertraline1NoCase history; night sweats resolved with discontinuation of sertraline suggest night sweats may be sign of “serotonin syndrome”83
    Venlafaxine1Case history; night sweats resolved when drug was discontinued84
    Efavirenz1NoCase history; night sweats resolved with discontinuation of drug85
    Neoplastic and hematologicHemangioma, hepatic1NoNight sweats resolved when hemangioma removed86
    Lymphoma85No4/14 (29%) with EBV Hodgkin disease had night sweats; in 75%, night sweats improved after treatment of disease87
    Lymphadenopathy258Yes14/85 (17%) patients with TB had night sweats
    24/98 (25%) patients with lymphoma had night sweats
    5/17 (29%) patients with metastatic cancer had night sweats
    0/6 (0%) of patients with sarcoidosis had night sweats
    5.36 (14%) of patients with nonspecific reactive hyperplasia had night sweats88
    Myelofibrosis24No21/24 (88%) night sweats improved >50% with JAK1 and JAK2 inhibitor treatment89
    Prostate cancer, inflammatory1NoCase study; treated, night sweats resolved90
    Psychiatric/behavioralDepression
        HIV+ and depressed62Yes16/28 (57%) had night sweats
        HIV+ and not depressed7/34 (21%)91
    Night terrors1NoCase study, night sweats resolved with treatment for posttraumatic syndrome92
    Panic disorder175No26/175 (15%) of attacks occurred at night;
    Sleep disturbance46/175 (26%) associated with sweating93
        Obstructive sleep apnea
        Snoring/daytime sleepiness4680Yes14/202 (14%) with snoring/sleepiness;
        No snoring/sleepiness179/4478 (4%) with no snoring/sleepiness58
        Apnea–hypopnea index ≥15282YesSubjective night sweats in 28/114 (25%)
        Apnea–hypopnea index <15Subjective night sweats in 50/167 (30%)38
    • GI, gastrointestinal; GERD, gastroesophageal reflux disease; IV, intravenous; TB, tuberculosis; URI, upper respiratory infection; EBV, Epstein-Barr virus; MAC, Mycobacterium avium complex.

    • View popup
    Table 5. Prevalence of Subjective Night Sweats (Elicited) among Patients with Medical Conditions
    ConditionPrevalence in Specific Samples
    Autoimmune diseases
        Polymorphic reticulosis7/34 (21%)94
    Endocrine diseases
        Diabetes mellitus14/22 (64%) with nocturnal hypoglycemia95
        Obesity, severe in residential treatment of obesity20/152 (13%) men; 47/234 (20%) women96
    Infectious diseases
        Adenovirus, immunocompromised4/15 (27%)97
        Endocarditis, Cardiobacterium hominis14/61 (24%)98
        HIV, acute5/58 (9%) of p24 Ag+/HIV−66
    7/20 (35%)99
    59/328 (18%)67
    88/151 (58%)100
        HIV, chronic18/22 (82%)68
    39/328 (12%)67
    19/49 (31%)101
    126/899 (14%)73
    7/34 (21%)91
    40/168 (24%)102
    26/100 (26%)103
    62/109 (57%)104
    144/205 (70%) (average once/week)105
    18/176 (10%) with no AIDS-defining illnesses50
        HIV+, IV drug users33/124 (27%)69
        HIV+, generalized lymphadenopathy12/38 (32%)71
        HIV+, Mycobacterium avium complex36/91 (40%)106
    27/31 (87%)74
    21/25 (84%)75
    18/24 (75%)76
    67/187 (36%)77
        HIV+, Pneumocystis carinii pneumonia46/99 (46%)107
        HIV+, pneumonia, bacterial22/94 (23%)107
        HIV+, tuberculosis66/85 (78%)*108
    306/899 (34%)73
    With pleural effusion 54/65 (83%)109
    19/36 (53%)107
    24/48 (50%)72
        Pneumonia, bacterial104/329 (32%)110
        Tuberculosis22/40 (55%)111
    Young adults 179/419 (43%), older adults 15/45 (33%)112
    Young adults 34/73 (46%), older adults 17/72 (24%)113
    Young adults 48/88 (55%), older adults 9/50 (18%)114
    Young adults 14/29 (48%)115
    Older adults 2/35 (6%)115
    12/17 (71%)110
    24/98 (25%) TB patients presenting with lymphadenopathy88
    148/313 (48%) of TB outpatients116
    11/31 (35%) of TB outpatients72
        Tuberculosis, Beijing typeYoung adults 14/29 (48%)
    Older adults 2/35 (6%)115
        Tuberculosis
            Beijing308/880 (35%)
            Non-Beijing type378/880 (43%)117
            Beijing2/21 (10%)
            Non-Beijing type7/20 (35%)118
        Tuberculosis, extrapulmonary99/209 (48%) of patients with abdominal TB119
    Medications28/54 (54%) with extrapulmonary TB116
        Oblimersen sodium7/40 (18%)120
        Tacatuzumab2/12 (17%)121
    Miscellaneous diseases
        Inflammatory pseudotumor2/25 (8%)122
    Neoplastic and hematologic diseases
        Acute lymphocytic leukemia8/10 (80%)123
        Acute myelocytic leukemia8/22 (36%)123
        Lymphoma14/85 (17%) of those presenting with lymphadenopathy88
    7/50 (14%) with generalized lymphadenopathy71
    3/10 (30%) lymphoma primary in liver124
    4/14 (29%) with EBV Hodgkin disease87
    5/12 (42%) with pancreatic lymphoma87
        Metastatic, mixed5/17 (29%) of those presenting with lymphadenopathy88
        Mesothelioma, peritoneal3/17 (18%)125
        Mixed, terminal12/77 (16%) admission to hospice
    19/77 (25%) just before death126
        Myelofibrosis255/456 (56%)127
    8/22 (36%)128
    12/56 (21%)129
        Pancreatic cancer1/30 (3%)130
        Polycythemia vera198/405 (49%)127
        Prostate cancer, inflammatory7/12 (58%)90
        Thrombocythemia, essential125/304 (41%)127
    Pulmonary diseases
        Eosinophilic pneumonia3/65 (5%)131
    Sleep disorders
        Obstructive sleep apnea65/406 (16%)132
    Toxic and metabolic diseases
        Silicone breast implants22/50 (44%)133
    • ↵* Compilation of several case series.

    • EBV, Epstein-Barr virus; IV, intravenous; TB, tuberculosis.

    • View popup
    Table 6. Case Studies of Treatments Reported to Be Effective for Patients with Night Sweats
    PopulationTreatment (Route of Administration Cited Only Where Provided)Effectiveness
    Patients with advanced cancer, referred for palliative careNabilone at 1 mg at bedtime or twice a day4/4 patients' night sweats improved (mean 5.75 points on the ESAS)134
    Patients with terminal cancerThalidomide at 100 mg at bedtime6 /7 patients improved an average of 4 points on a 5-point scale; recurred off of drug and improved again with reinstitution of drug135
    Patients with advanced local or metastatic cancerThioridazine at 10–30 mg at bedtime nightly15/17 patients reported improvement, poorly quantified136
    Patients with myelofibrosisEtanercept at 25 mg subcutaneously twice weekly for up to 24 weeks6/8 (75%) improved with treatment128
    Patients treated for narcotic addiction with methadoneDesloratadine at 5 mg per day2/2 (100%) reported relief from night sweats within 1 day137
    Patients taking SSRIsMirtazapine at 15–60 mg per dayOne case: dose-dependent reduction in night sweats138
    Patients taking SSRIsBenztropine at 0.5 mg at bedtimeOne case: temporary relief from night sweats84
    Patients taking SSRIsTerazosin at 1 mg per day to 2 mg at bedtimeSignificant reduction in night sweats in 2/2 (100%), one after a day, the other after 4 weeks139
    Patients taking SSRIsTerazosinSignificant reduction in night sweats in 20/20 (100%)140
    Patients taking SSRIsClonidine at 0.1 mg twice dailyOne case: significant relief of night sweats after 3 week139
    • SSRIs, selective serotonin reuptake inhibitors; ESAS, Edmonton Symptom Assessment System (scored 0–10).

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Night Sweats: A Systematic Review of the Literature
James W. Mold, Barbara J. Holtzclaw, Laine McCarthy
The Journal of the American Board of Family Medicine Nov 2012, 25 (6) 878-893; DOI: 10.3122/jabfm.2012.06.120033

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Night Sweats: A Systematic Review of the Literature
James W. Mold, Barbara J. Holtzclaw, Laine McCarthy
The Journal of the American Board of Family Medicine Nov 2012, 25 (6) 878-893; DOI: 10.3122/jabfm.2012.06.120033
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