Article Figures & Data
Tables
Authors/Year Purpose Definition Lister et al, 198947 Clinical and research “Recurrent drenching night sweats during the previous month” Smetana, 199353 Clinical “Drenching sweats that require changing bed clothes” Holtzclaw, 199654 Clinical “A nonspecific term that refers to heavy sweating during sleep” Chambliss, 199944 Clinical “Unusual sweating that occurs only or mainly at night” Mold et al, 200838 Clinical “Sweating excessively during the night during the past month” Mold et al, 200237 Research “Sweating at night even when it is not excessively hot in your bedroom during the past month” Lea and Aber, 198555 Research Mild: “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, 199756 Research Mild: “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” Authors/Year Population (Country) N Prevalence and Incidence Estimates Lea and Aber, 198555 Hospital inpatients (US) 174 Prevalence: medicine: 33% Surgery: 33% Obstetrics: 60% Gynecology: 27% Reynolds, 198957 Consecutive patients seen in a gastroenterology practice* 200 Prevalence: 41% Quigley and Baines, 199756 Hospice inpatients patients, consecutive admissions (UK) 100 Prevalence: 16% overall 12% soaked bed clothes Mold et al, 200237 Primary care patients, consecutive visits (US) 2267 Prevalence: all: 41% Nighttime only: 23% 4–7 nights per week: 16% Mold et al, 200440 Primary care patients >65 years of age, recruited from billing records (US) 795 Prevalence: 10% Mold et al, 200639 Primary care patients, consecutive visits (US) 363 Prevalence: 34% 17% soaked bed clothes Mold et al, 200838 Consecutive patients undergoing polysomnography (US) 282 Prevalence: 28% Mold and Lawler, 201046 Consecutive patients >65 years of age enrolled in a primary care geriatric continuity clinic (US)* 682 Prevalence: 14% past year Mold and Lawler, 201046 Primary care patients >65 years of age, recruited from billing records (US) 795 Incidence (annual): 5% Suwanprathes et al, 201058 Random population sample, (Bangkok, Thailand)* 4680 Prevalence: 4.4% -
↵* Night sweats definition not provided in report.
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Authors/Year Study Design Analytic Method Factors Associated with Night Sweats Lea and Aber, 198555 Cross-sectional χ2 Aspirin or acetaminophen use (P < 0.05) Mold et al, 200237 Cross-sectional Logistic regression All: 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, 200440 Cross-sectional Logistic regression Age (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 analysis Impaired 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, 200639 Cross-sectional Logistic regression Daytime 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, 200838 Cross-sectional Logistic regression Trouble 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.
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- Table 4. Evidence Supporting Associations between Clinical Conditions and Elicited Subjective Night Sweats
Clinical Disorder N Comparative Data Proportion with Night Sweats (if Comparison Group) or Proportion in Whom Night Sweats Resolved with Treatment Autoimmune POEMS syndrome 1 No Disorder treated, night sweats resolved59 Rheumatoid arthritis 1 No Disorder treated, night sweats resolved60 Giant cell arteritis 1 No Disorder treated, night sweats resolved61 Cardiovascular Aortic dissection, chronic 1 No Disorder treated, night sweats resolved62 Nocturnal/Prinzmetal angina 1 No Disorder treated, night sweats persisted63 Endocrine Diabetes insipidus 1 No Disorder treated/night sweats resolved64 Hyperthyroidism 1 No Disorder treated, night sweats resolved65 GI GERD 12 No Disorder treated, night sweats resolved (100%)57 Infectious disease HIV P24 Ag+, HIV− 3816 Yes 5/58 (9%) P24 Ag−, HIV− 38/3758 (1%)66 HIV-negative 328 Yes 20/328 (6%) night sweats Acute HIV+ 59/328 (18%) Chronic HIV+ 39/328 (12%)67 HIV seroconverters 110 Yes 18/22 (82%) night sweats Nonseroconverters 6/88 (7%)68 IV drug users, HIV+ 223 Yes 33/124 (27%) night sweats IV drug users, HIV− 13/99 (13%)69 Hodgkin disease, HIV+ 16 Yes 2/5 (40%) night sweats Hodgkin disease, HIV− 3/11 (27%)70 HIV+ with persistent generalized lymphadenopathy 88 Yes 12/38 (32%) night sweats HIV+ with lymphoma 7/50 (14%)71 TB patients, HIV+ 158 Yes 24/48 (50%) TB patients, HIV− 11/31 (35%)72 HIV patients, TB+ 899 Yes 15/44 (34%) night sweats 108/855 (14%)73 HIV patients, TB− 31 No 27/31 (87%) 4.8 episodes per week pretreatment; 1.6 episodes/week posttreatment74 HIV+, MAC 25 No 21/25 (84%) had night sweats pretreatment; post treatment one of 25 (4%) had night sweats75 24 No 18/24 (75%) had night sweats pretreatment; posttreatment 6/24 (25%) had night sweats76 187 No 67/187 (36%) had night sweats pretreatment; posttreatment 40% had fewer night sweats when treated with 4 drugs; 1748 Yes 70% 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/Mononucleosis 356 Yes Cohort 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) 101 Yes No significant difference in rate of night sweats between those with TB and those without TB80 Hospitalized patients in isolation awaiting diagnosis 563 Yes 26/47 (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 TB 145 Yes 13/28 (46%) with positive sputum reported night sweats; 29/113 (26%) with negative sputum reported night sweats51 Hospitalized patients awaiting TB diagnosis 101 Yes 44/100 were TB-positive; no association between reported night sweats and TB positivity80 Cysticercosis (Coenurus) 1 No Case history; night sweats and lymphoma-like symptoms ceased with excision of larval cysts82 Medications Antidepressants Sertraline 1 No Case history; night sweats resolved with discontinuation of sertraline suggest night sweats may be sign of “serotonin syndrome”83 Venlafaxine 1 Case history; night sweats resolved when drug was discontinued84 Efavirenz 1 No Case history; night sweats resolved with discontinuation of drug85 Neoplastic and hematologic Hemangioma, hepatic 1 No Night sweats resolved when hemangioma removed86 Lymphoma 85 No 4/14 (29%) with EBV Hodgkin disease had night sweats; in 75%, night sweats improved after treatment of disease87 Lymphadenopathy 258 Yes 14/85 (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 Myelofibrosis 24 No 21/24 (88%) night sweats improved >50% with JAK1 and JAK2 inhibitor treatment89 Prostate cancer, inflammatory 1 No Case study; treated, night sweats resolved90 Psychiatric/behavioral Depression HIV+ and depressed 62 Yes 16/28 (57%) had night sweats HIV+ and not depressed 7/34 (21%)91 Night terrors 1 No Case study, night sweats resolved with treatment for posttraumatic syndrome92 Panic disorder 175 No 26/175 (15%) of attacks occurred at night; Sleep disturbance 46/175 (26%) associated with sweating93 Obstructive sleep apnea Snoring/daytime sleepiness 4680 Yes 14/202 (14%) with snoring/sleepiness; No snoring/sleepiness 179/4478 (4%) with no snoring/sleepiness58 Apnea–hypopnea index ≥15 282 Yes Subjective night sweats in 28/114 (25%) Apnea–hypopnea index <15 Subjective 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.
- Table 5. Prevalence of Subjective Night Sweats (Elicited) among Patients with Medical Conditions
Condition Prevalence in Specific Samples Autoimmune diseases Polymorphic reticulosis 7/34 (21%)94 Endocrine diseases Diabetes mellitus 14/22 (64%) with nocturnal hypoglycemia95 Obesity, severe in residential treatment of obesity 20/152 (13%) men; 47/234 (20%) women96 Infectious diseases Adenovirus, immunocompromised 4/15 (27%)97 Endocarditis, Cardiobacterium hominis 14/61 (24%)98 HIV, acute 5/58 (9%) of p24 Ag+/HIV−66 7/20 (35%)99 59/328 (18%)67 88/151 (58%)100 HIV, chronic 18/22 (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 users 33/124 (27%)69 HIV+, generalized lymphadenopathy 12/38 (32%)71 HIV+, Mycobacterium avium complex 36/91 (40%)106 27/31 (87%)74 21/25 (84%)75 18/24 (75%)76 67/187 (36%)77 HIV+, Pneumocystis carinii pneumonia 46/99 (46%)107 HIV+, pneumonia, bacterial 22/94 (23%)107 HIV+, tuberculosis 66/85 (78%)*108 306/899 (34%)73 With pleural effusion 54/65 (83%)109 19/36 (53%)107 24/48 (50%)72 Pneumonia, bacterial 104/329 (32%)110 Tuberculosis 22/40 (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 type Young adults 14/29 (48%) Older adults 2/35 (6%)115 Tuberculosis Beijing 308/880 (35%) Non-Beijing type 378/880 (43%)117 Beijing 2/21 (10%) Non-Beijing type 7/20 (35%)118 Tuberculosis, extrapulmonary 99/209 (48%) of patients with abdominal TB119 Medications 28/54 (54%) with extrapulmonary TB116 Oblimersen sodium 7/40 (18%)120 Tacatuzumab 2/12 (17%)121 Miscellaneous diseases Inflammatory pseudotumor 2/25 (8%)122 Neoplastic and hematologic diseases Acute lymphocytic leukemia 8/10 (80%)123 Acute myelocytic leukemia 8/22 (36%)123 Lymphoma 14/85 (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, mixed 5/17 (29%) of those presenting with lymphadenopathy88 Mesothelioma, peritoneal 3/17 (18%)125 Mixed, terminal 12/77 (16%) admission to hospice 19/77 (25%) just before death126 Myelofibrosis 255/456 (56%)127 8/22 (36%)128 12/56 (21%)129 Pancreatic cancer 1/30 (3%)130 Polycythemia vera 198/405 (49%)127 Prostate cancer, inflammatory 7/12 (58%)90 Thrombocythemia, essential 125/304 (41%)127 Pulmonary diseases Eosinophilic pneumonia 3/65 (5%)131 Sleep disorders Obstructive sleep apnea 65/406 (16%)132 Toxic and metabolic diseases Silicone breast implants 22/50 (44%)133 -
↵* Compilation of several case series.
EBV, Epstein-Barr virus; IV, intravenous; TB, tuberculosis.
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- Table 6. Case Studies of Treatments Reported to Be Effective for Patients with Night Sweats
Population Treatment (Route of Administration Cited Only Where Provided) Effectiveness Patients with advanced cancer, referred for palliative care Nabilone at 1 mg at bedtime or twice a day 4/4 patients' night sweats improved (mean 5.75 points on the ESAS)134 Patients with terminal cancer Thalidomide at 100 mg at bedtime 6 /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 cancer Thioridazine at 10–30 mg at bedtime nightly 15/17 patients reported improvement, poorly quantified136 Patients with myelofibrosis Etanercept at 25 mg subcutaneously twice weekly for up to 24 weeks 6/8 (75%) improved with treatment128 Patients treated for narcotic addiction with methadone Desloratadine at 5 mg per day 2/2 (100%) reported relief from night sweats within 1 day137 Patients taking SSRIs Mirtazapine at 15–60 mg per day One case: dose-dependent reduction in night sweats138 Patients taking SSRIs Benztropine at 0.5 mg at bedtime One case: temporary relief from night sweats84 Patients taking SSRIs Terazosin at 1 mg per day to 2 mg at bedtime Significant reduction in night sweats in 2/2 (100%), one after a day, the other after 4 weeks139 Patients taking SSRIs Terazosin Significant reduction in night sweats in 20/20 (100%)140 Patients taking SSRIs Clonidine at 0.1 mg twice daily One case: significant relief of night sweats after 3 week139 SSRIs, selective serotonin reuptake inhibitors; ESAS, Edmonton Symptom Assessment System (scored 0–10).
In this issue
Night Sweats: A Systematic Review of the Literature
