Where do night sweats fall in the review of systems?

Night Sweats in the Review of Systems

Night sweats fall under the "General" category in the review of systems, specifically listed among constitutional symptoms. 1

Placement in Review of Systems Structure

Night sweats are categorized as follows:

• General/Constitutional: Night sweats are explicitly included in this section alongside other symptoms such as:
  • Unexplained weight loss 1
  • Fever 1
  • Changes in body habitus 1

Clinical Significance of Night Sweats in ROS

Night sweats are important to include in the review of systems because they can indicate:

• Infectious processes: Particularly tuberculosis and HIV-related opportunistic infections 2, 3
• Malignancies: Especially lymphomas and other hematologic malignancies 3
• Endocrine disorders: Such as hyperthyroidism 4
• Myeloproliferative disorders: Night sweats are part of the diagnostic criteria for post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosis 1
• Menopause: Common cause in women of appropriate age 3
• Medication effects: Certain medications can cause night sweats as a side effect 5

Documentation in Clinical Practice

When documenting night sweats in the review of systems:

• Record frequency, severity, and pattern (e.g., drenching vs. mild) 2, 3
• Note associated symptoms, particularly:
  • Weight loss 1
  • Fever 1
  • Cough (especially for TB consideration) 2
  • Lymphadenopathy (for lymphoma consideration) 3

Clinical Pearls

• Night sweats alone in primary care patients without other concerning symptoms often do not indicate serious underlying disease 6, 4
• The presence of night sweats combined with B symptoms (fever, weight loss) significantly increases concern for serious pathology 3, 7
• Common but often overlooked causes in primary care include:
  • Gastroesophageal reflux disease 8, 4
  • Obstructive sleep apnea 4, 9
  • Mood disorders 4
  • Obesity 4

Common Pitfalls to Avoid

• Failing to distinguish between normal nocturnal perspiration and pathological night sweats (defined as drenching sweats that require changing clothes/bedding) 6, 9
• Over-investigation of isolated night sweats without other symptoms in otherwise healthy individuals 6, 4
• Missing medication-related causes, including antihypertensives and serotonin reuptake inhibitors 5, 9

Algorithmic Approach When Night Sweats Are Reported

1. Determine severity and frequency of night sweats 2, 4
2. Assess for associated symptoms (weight loss, fever, cough, lymphadenopathy) 1, 3
3. Consider age and sex-specific causes (menopause in women) 3, 4
4. Review medication list for potential causes 5, 9
5. For persistent, unexplained night sweats, consider basic workup including:
   • Complete blood count 4, 9
   • Tuberculosis testing 4, 9
   • Thyroid-stimulating hormone 4, 9
   • HIV testing when appropriate 4, 9
   • Chest radiography 4, 9