From the Guidelines
Night sweats that have persisted for many years require a comprehensive workup to identify the underlying cause, starting with a review of the patient's medical history, focusing on "SCREeN" conditions, including sleep medicine, cardiovascular, renal, endocrine, and neurological diseases, as outlined in the Planet study 1. When evaluating night sweats, it is essential to consider various underlying conditions that may be contributing to the symptoms. A detailed medical history should be taken, including the pattern, severity, and associated symptoms of the night sweats. Key areas to explore in the medical history include:
- Sleep medicine: insomnia, restless legs syndrome, periodic limb movements of sleep, parasomnias, and obstructive sleep apnea
- Cardiovascular: hypertension, congestive heart failure
- Renal: chronic kidney disease
- Endocrine: diabetes mellitus, overactive or underactive thyroid, pregnancy, menopause, diabetes insipidus, and testosterone deficiency
- Neurological: various neurological diseases A physical examination should be performed, followed by basic laboratory tests, such as complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, thyroid function tests, and fasting blood glucose. If these initial tests are unrevealing, consider additional testing, such as tuberculosis screening, HIV testing, and a chest X-ray. For women, hormonal evaluation may be appropriate to assess for perimenopause or menopause. Medication review is essential, as certain drugs, like antidepressants, hormone therapies, and antibiotics, can cause night sweats 1. While awaiting diagnosis, symptom management includes sleeping in lightweight clothing, using breathable bedding, maintaining a cool bedroom temperature, and avoiding alcohol, caffeine, and spicy foods before bedtime. Persistent night sweats can indicate serious underlying conditions, including infections, malignancies, endocrine disorders, or neurological conditions, so thorough evaluation is crucial, even when symptoms have been present for many years.
From the Research
Night Sweats: Causes and Evaluation
- Night sweats are a nonspecific symptom that can be caused by various conditions, including menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity 2, 3, 4.
- In some cases, night sweats can be a symptom of a more serious underlying condition, such as tuberculosis or lymphoma 3, 5.
- A thorough history and physical examination are essential in evaluating night sweats, and laboratory and imaging studies may be necessary to rule out underlying conditions 2, 3, 5.
Diagnostic Approach
- A systematic and cost-conscious approach to evaluation is recommended, including laboratory tests such as complete blood count, tuberculosis testing, thyroid-stimulating hormone levels, HIV testing, and C-reactive protein level 2, 3.
- Imaging studies such as chest radiography and computed tomography of the chest and/or abdomen may also be considered 2, 3, 5.
- A medication review and screening for infections and sleeping disorders are also important components of the diagnostic approach 5, 4.
Treatment and Prognosis
- Treatment of night sweats depends on the underlying cause, and specific treatment may be offered if a clinical diagnosis is apparent 2.
- In some cases, reassurance and continued monitoring may be recommended if no underlying condition is found 2, 4.
- The presence of night sweats alone does not indicate an increased risk of death, and life expectancy of primary care patients reporting night sweats does not appear to be reduced 2, 4.