Sleep hyperhidrosis associated with obstructive sleep apnea in the context of systemic lupus erythematosus: case report

Abstract

This is an 81-year-old patient referred to a rheumatologist due to positive ANA in addition to intense night sweating and nighttime awakenings throughout a period of four months, as well as non-restorative sleep, fatigue and excessive daytime sleepiness, hyporexia and significant weight loss (09 kilos during the referred period). Tests were requested to exclude more serious causes, such as lymphoma, tuberculosis and pheochromocytoma. In addition, polysomnography was requested, which showed a severe apnea hypopnea index due to obstructive events (AHI = 45.2/ hour), an increased rate of awakenings (awakening index = 27.9/ hour) and oxyhemoglobin desaturation associated with respiratory events with a minimum saturation of 84% and the presence of snoring, therefore compatible with severe obstructive sleep apnea syndrome. Furthermore, it is important to note that during subsequent consultations the patient was also identified as having Systemic Lupus Erythematosus (SLE). Night hyperhidrosis, a clinical condition characterized by exacerbated and unregulated sweat production that interferes with sleep quality, is correlated with obstructive sleep apnea syndrome (OSAS), when untreated, is responsible for an increase in sympathetic activity that affects sleep and awakening, in a feedback loop. The first condition, SLE, little discussed in literature, has its diagnosis dependent on clinical suspicion and the recognition of possible secondary causes. The SAOS treatment proposal for the patient was the introduction of positive airway pressure treatment, with a nasal mask, in addition to conservative measures. Furthermore, SLE was satisfactorily treated with control of the lupus and nocturnal hyperhidrosis, as well as the nocturnal symptoms associated with OSAS.