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==Overview==
==Overview==
'''Sleep hyperhidrosis''', more commonly known as the '''night sweats''', is the occurrence of excessive sweating ([[hyperhidrosis]]) during [[sleep]]. It may cause the patient to wake up because of wet sleepwear. The sufferer may or may not also suffer from excessive perspiration while awake. A night sweat caused by a medical condition or infection can be described as ‘severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment’. [http://www.medicinenet.com/script/main/art.asp?articlekey=57394] True night sweats with medical causes should be properly investigated by a medical physician.
'''Sleep hyperhidrosis''', more commonly known as the '''night sweats''', is the occurrence of excessive sweating ([[hyperhidrosis]]) during [[sleep]]. The sufferer may or may not also suffer from excessive perspiration while awake. A night sweat caused by a medical condition or infection can be described as ‘severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment’. [http://www.medicinenet.com/script/main/art.asp?articlekey=57394] True night sweats with medical causes should be properly investigated by a medical physician.


==Classification of Sweating==
==Classification of Sweating==
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Sleep hyperhidrosis may occur at any age, but is most commonly seen in early [[adult]]hood.
Sleep hyperhidrosis may occur at any age, but is most commonly seen in early [[adult]]hood.


==Genetics==
==Risk factors==
Night sweats may occur for [[genetics|genetic]] reasons and may be relatively harmless. However, they can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.
* [[Sleep hydrosis]] can occur at any age, but is most common during childhood.
* No differences in men or women.
* Night sweats may occur for [[genetics|genetic]] reasons and may be relatively harmless.  


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
While some causes of night sweats, such as [[menopause]], may be relatively harmless, night sweats may also be a sign of a serious underlying disease.
* The natural history is unpredictable. Some patients may have a self-limited course, where as some may experience [[sleep hydrosis]] for life.
* They can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.
* While some causes of night sweats, such as [[menopause]], may be relatively harmless, night sweats may also be a sign of a serious underlying disease.
 
 
 


==Causes==
==Causes==
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| • [[Diabetes] • [[Hyperthyroidism]] • [[Hypoglycemia]] • [[Hypothalamus|Hypothalamic]] lesions
|bgcolor="Beige"| • [[Diabetes] • [[Hyperthyroidism]] • [[Hypoglycemia]] • [[Hypothalamus|Hypothalamic]] lesions • [[Diabetes Insipidus]] • [[Pheochromocytoma]]
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| • [[Cerebral palsy]] • [[Telencephalon|Cerebral]] and [[brain stem]] [[stroke]]s • [[Epilepsy]] • [[Familial dysautonomia]]
|bgcolor="Beige"| • [[Cerebral palsy]] • [[Telencephalon|Cerebral]] and [[brain stem]] [[stroke]]s • [[Epilepsy]] • [[Familial dysautonomia]] • [[Chronic paroxysmal hemicrania]] • [[Spinal cord infarction]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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=== Physical Examination ===  
=== Physical Examination ===  
*Full exam with focus on endocrine, dermatologic and lymphatic systems
*Full exam with focus on endocrine, dermatologic and lymphatic systems
===Polysomnography===
No specific features have been reported.


=== Echocardiogram===  
=== Echocardiogram===  
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*[[Free T4]]
*[[Free T4]]
*[[5-hydroxyindoleacetic acid]]
*[[5-hydroxyindoleacetic acid]]
* Quinizarin powder, turns purple on contact with sweat, can help in localizing the area of excessive sweating.


=== MRI and CT ===  
=== MRI and CT ===  

Revision as of 20:36, 12 May 2012

Sleep hyperhidrosis
ICD-10 R61.9
ICD-9 780.8, 327

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake. A night sweat caused by a medical condition or infection can be described as ‘severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment’. [2] True night sweats with medical causes should be properly investigated by a medical physician.

Classification of Sweating

There are four types of sweats:

  1. Diaphoresis: Diaphoresis is a cold sweat. Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. It is distinguished from hyperhidrosis by the "clammy" or "cold state" state of the patient.
  2. Primary Hyperhidrosis: Primary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. This is not a cold sweat.
  3. Secondary Hyperhidrosis: Secondary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature that is secondary to an underlying pathologic process such as infections, disorders of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. This is not a cold sweat.
  4. Night sweats: Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake.

Epidemiology and Demographics

Sleep hyperhidrosis may occur at any age, but is most commonly seen in early adulthood.

Risk factors

  • Sleep hydrosis can occur at any age, but is most common during childhood.
  • No differences in men or women.
  • Night sweats may occur for genetic reasons and may be relatively harmless.

Natural History, Complications and Prognosis

  • The natural history is unpredictable. Some patients may have a self-limited course, where as some may experience sleep hydrosis for life.
  • They can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.
  • While some causes of night sweats, such as menopause, may be relatively harmless, night sweats may also be a sign of a serious underlying disease.



Causes

Common Causes

One of the most common causes of night sweats in women over 40 is the hormonal changes related to menopause and perimenopause. This is a normal part of menopause and while annoying, it is not necessarily dangerous or a sign of underlying disease. Some women experience night sweats during pregnancy due to hormonal changes.

While there can be many causes of excessive sweating at night including the menopause and, for example, a bedroom that is unusually hot or too many bed clothes on the bed, it is important to distinguish night sweats that arise due to medical causes from those that occur because the sleep environment is too warm.

Complete differential diagnosis of causes of Sleep hyperhidrosis by organ system

(By organ system)

Cardiovascular • Prinzmetal's angina • Subacute endocarditis • Takayasu's arteritis•Temporal arteritis
Chemical / poisoning • Alcohol withdrawl • Benzodiazepine withdrawl • Opiate withdrawl [[Acrodynia (childhood mercury poisoning)•
Drug Side Effect • Beryllium • Abatacept Injection (patient information) • Adalimumab Injection (patient information) • Camphoric acid •Creeping Cinquefoil • Cyclosporine (patient information) • Estroven • Imatinib (patient information) • Lamotrigine • Letrozole (patient information) • Leuprolide (patient information)Levomepromazine • Natalizumab injection (patient information) • Pegaspargase (patient information) • Pentamidine Inhalation (patient information) • Rituximab injection (patient information) • Sertraline •Trenbolone
Endocrine • [[Diabetes] • Hyperthyroidism • Hypoglycemia • Hypothalamic lesions • Diabetes Insipidus • Pheochromocytoma
Gastroenterologic • Gastroesophageal reflux disease
Genetic No underlying causes
Hematologic • Polycythemia vera • Waldenstrom's macroglobulinemia
Iatrogenic • Orchiectomy
Infectious Disease • Lung abscess • Mononucleosis • Mycobacterium avium complex infection • Nocardiosis • Blastomycosis • Brucellosis• Chronic eosinophilic pneumonia • Eosinophilic pneumonia • Fungal infection • HIV • Osteomyelitis • Pneumocystis pneumonia •Histomplasmosis • Relapsing fever • Tuberculosis • Urinary tract infection • Influenza • Lyme disease
Musculoskeletal / Ortho • Osteotomy • Fibromyalgia
Neurologic • Cerebral palsy • Cerebral and brain stem strokes • Epilepsy • Familial dysautonomia • Chronic paroxysmal hemicrania • Spinal cord infarction
Nutritional / Metabolic • Obesity • Anorexia Nervosa
Obstetric/Gynecologic • Menopause • Pregnancy
Oncologic • Lymphoma • Mantle cell lymphoma • B symptoms • Occult malignancy • Hodkin's disease • Leukemia • Solid tumors[1] [2]
Overdose/Toxicity Substance abuse
Psychiatric • Anxiety disorders • Posttraumatic stress disorder
Pulmonary • Asthma • Obstructive sleep apnea
Renal / Electrolyte • No underlying causes
Rheum / Immune / Allergy • Kikuchi disease • Sarcoidosis
Trauma • Head injury
Miscellaneous • Chronic fatigue syndrome • Excess bed covers • Tree marigold • Warm bedroom

Diagnosis

History and Symptoms

  • History:
  • Medical history should focus on potential infectious and oncologic causes
  • Social history should focus on substance abuse and travel

Physical Examination

  • Full exam with focus on endocrine, dermatologic and lymphatic systems

Polysomnography

No specific features have been reported.

Echocardiogram

An echocardiogram can be obtained if there is a high suspicion of endocarditis

Laboratory Findings

The folowing laboratory studies may be of use in determining the underlying cause of nightsweats.

More sophisticated laboratory studies would include the following:

MRI and CT

  • Suggest MRI/CT if necessary (chest/abdomen/pelvis)

Treatment

Treat the underlying etiology with appropriate therapy

Acute Pharmacotherapies

  • Ibuprofen or acetaminophen
  • Antimicrobial if infection is the cause

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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