{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:21:21Z","timestamp":1787062881565,"version":"build-2736575974"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T00:00:00Z","timestamp":1612742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish government and the county councils, the ALF-agreement","award":["ALFGBG-587911"],"award-info":[{"award-number":["ALFGBG-587911"]}]},{"DOI":"10.13039\/501100005689","name":"Gothenburg Medical Society","doi-asserted-by":"crossref","award":["18\/783261"],"award-info":[{"award-number":["18\/783261"]}],"id":[{"id":"10.13039\/501100005689","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Healthcare Committee, Region V\u00e4stra G\u00f6taland","award":["VGFOUREG-477111"],"award-info":[{"award-number":["VGFOUREG-477111"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    Tick-borne encephalitis (TBE) is a widespread viral infection of the central nervous system with increasing incidence in Europe and northern Asia. Post-infectious sequelae are frequent, and patients with TBE commonly experience long-term fatigue and subjective sleep disturbances. Obstructive sleep apnea (OSA) may be a contributing factor, and objective sleep studies with polysomnography (PSG) are lacking. Forty-two adults, 22 TBE patients (cases), diagnosed in Region V\u00e4stra G\u00f6taland, Sweden, between 2012 and 2015, and 20 controls without a known TBE history, underwent an overnight PSG, respectively. All participants responded to questionnaires. The cases and controls were similar regarding age, sex, obesity, concomitant diseases, smoking, and alcohol habits. Despite similar PSG characteristics such as total sleep time and OSA severity indices, the TBE cases reported statistically more sleep-related functional impairment on the Functional Outcome of Sleep Questionnaire (FOSQ) compared with the controls (median scores 18.1\n                    <jats:italic>vs<\/jats:italic>\n                    . 19.9;\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.05). In a multivariate analysis, TBE correlated significantly with the lower FOSQ scores (unstandardized \u03b2 \u22121.80 [%95 confidence interval \u22123.02 - \u22120.58];\n                    <jats:italic>p = 0<\/jats:italic>\n                    .\n                    <jats:italic>005<\/jats:italic>\n                    ) independent of age, sex, total sleep time and apnea-hypopnea-index. TBE cases with OSA reported the lowest scores on the FOSQ compared with the other subgroups with TBE or OSA alone, and the ones with neither TBE nor OSA. TBE is associated with impaired functional outcomes, in which concomitant OSA may worsen the subjective symptoms. Further studies are warranted to determine the effect of treatment of concomitant OSA on functional outcomes with regard to optimal rehabilitation of TBE.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0246767","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T19:33:53Z","timestamp":1612812833000},"page":"e0246767","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Sleep architecture, obstructive sleep apnea and functional outcomes in adults with a history of Tick-borne encephalitis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5487-0616","authenticated-orcid":true,"given":"Malin","family":"Veje","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Studahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Thunstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Stentoft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nolskog","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeliz","family":"Celik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-6538","authenticated-orcid":true,"given":"Y\u00fcksel","family":"Peker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,8]]},"reference":[{"key":"pone.0246767.ref001","unstructured":"Statistics from the Public Health Agency of Sweden, https:\/\/www.folkhalsomyndigheten.se\/folkhalsorapportering-statistik\/statistik-a-o\/sjukdomsstatistik\/tick-borne-encephalitis-tbe\/."},{"issue":"6","key":"pone.0246767.ref002","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1093\/jnen\/64.6.506","article-title":"Visualization of Central European tick-borne encephalitis infection in fatal human cases","volume":"64","author":"E Gelpi","year":"2005","journal-title":"J Neuropathol Exp Neurol"},{"issue":"4","key":"pone.0246767.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0154143","article-title":"Predictors, Neuroimaging Characteristics and Long-Term Outcome of Severe European Tick-Borne Encephalitis: A Prospective Cohort Study","volume":"11","author":"T Lenhard","year":"2016","journal-title":"PloS one"},{"key":"pone.0246767.ref004","doi-asserted-by":"crossref","first-page":"742","DOI":"10.12659\/PJR.903940","article-title":"Evaluation of Imaging Methods in Tick-Borne Encephalitis","volume":"82","author":"R Zawadzki","year":"2017","journal-title":"Pol J Radiol"},{"key":"pone.0246767.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jocn.2019.01.050","article-title":"The centromedian nucleus: Anatomy, physiology, and clinical implications","volume":"63","author":"A Ilyas","year":"2019","journal-title":"J Clin Neurosci"},{"issue":"6","key":"pone.0246767.ref006","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1086\/342059","article-title":"Tickborne encephalitis in an area of high endemicity in lithuania: disease severity and long-term prognosis","volume":"35","author":"A Mickiene","year":"2002","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"6","key":"pone.0246767.ref007","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/ane.12561","article-title":"Tick-Borne Encephalitis sequelae at long-term follow-up: a self-reported case-control study","volume":"134","author":"M Veje","year":"2016","journal-title":"Acta neurologica Scandinavica"},{"issue":"1","key":"pone.0246767.ref008","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/j.1468-1331.2011.03434.x","article-title":"Tick-borne encephalitis in Latvia 1973\u20132009: epidemiology, clinical features and sequelae","volume":"19","author":"G Karelis","year":"2012","journal-title":"European journal of neurology"},{"issue":"5","key":"pone.0246767.ref009","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/j.1468-1331.2010.03278.x","article-title":"Tick-borne encephalitis in Poland in years 1993-2008\u2014epidemiology and clinical presentation. A retrospective study of 687 patients","volume":"18","author":"P Czupryna","year":"2011","journal-title":"European journal of neurology"},{"issue":"7011","key":"pone.0246767.ref010","article-title":"Tick-borne meningoencephalomyelitis in Sweden","volume":"271","author":"G SA von Zeipel","year":"1958","journal-title":"Lancet (British edition)"},{"issue":"24","key":"pone.0246767.ref011","first-page":"909","article-title":"Late sequelae of early summer meningoencephalitis","volume":"130","author":"B L\u00e4mmli","year":"2000","journal-title":"Schweiz Med Wochenschr"},{"key":"pone.0246767.ref012","first-page":"115","article-title":"The Clinical Features of Tick-Borne Encephalitis in Slovenia. A study of 492 cases in 1994","volume":"12","author":"J PF Tomazic","year":"1996","journal-title":"Antibiotika Monitor"},{"issue":"2","key":"pone.0246767.ref013","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1053\/smrv.2001.0152","article-title":"Outcome measurement in sleep medicine practice and research. Part 1: assessment of symptoms, subjective and objective daytime sleepiness, health-related quality of life and functional status","volume":"5","author":"TE Weaver","year":"2001","journal-title":"Sleep Med Rev"},{"key":"pone.0246767.ref014","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.sleep.2018.09.025","article-title":"Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis","volume":"54","author":"X Huang","year":"2019","journal-title":"Sleep Med"},{"issue":"6","key":"pone.0246767.ref015","doi-asserted-by":"crossref","first-page":"e748","DOI":"10.1016\/S2214-109X(19)30045-2","article-title":"Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study","volume":"7","author":"A Rosengren","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pone.0246767.ref016","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/B978-0-444-64032-1.00025-4","article-title":"Polysomnography","volume":"160","author":"JV Rundo","year":"2019","journal-title":"Handb Clin Neurol"},{"issue":"5","key":"pone.0246767.ref017","first-page":"597","article-title":"Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine","volume":"8","author":"RB Berry","year":"2012","journal-title":"Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine"},{"issue":"3","key":"pone.0246767.ref018","first-page":"479","article-title":"Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline","volume":"13","author":"VK Kapur","year":"2017","journal-title":"Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine"},{"issue":"5","key":"pone.0246767.ref019","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1378\/chest.14-0970","article-title":"International classification of sleep disorders-third edition: highlights and modifications","volume":"146","author":"MJ Sateia","year":"2014","journal-title":"Chest"},{"issue":"10","key":"pone.0246767.ref020","first-page":"835","article-title":"An instrument to measure functional status outcomes for disorders of excessive sleepiness","volume":"20","author":"TE Weaver","year":"1997","journal-title":"Sleep"},{"issue":"6","key":"pone.0246767.ref021","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1093\/sleep\/30.6.711","article-title":"Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning","volume":"30","author":"TE Weaver","year":"2007","journal-title":"Sleep"},{"issue":"5","key":"pone.0246767.ref022","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3109\/00016357.2012.741708","article-title":"Psychometric evaluation of a Swedish version of the Functional Outcomes of Sleep Questionnaire, FOSQ","volume":"71","author":"L Korpe","year":"2013","journal-title":"Acta Odontol Scand"},{"issue":"6","key":"pone.0246767.ref023","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A new method for measuring daytime sleepiness: the Epworth sleepiness scale","volume":"14","author":"MW Johns","year":"1991","journal-title":"Sleep"},{"key":"pone.0246767.ref024","unstructured":"The Swedish translation of the Epworth Sleepiness Scale, 2001. Available from URL: https:\/\/www.swedishsleepresearch.com\/files\/user\/ess.pdf (accessed on 29\/11\/2020)."},{"issue":"5","key":"pone.0246767.ref025","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1682\/JRRD.2003.10.0013","article-title":"Critical outcomes in pulmonary rehabilitation: assessment and evaluation of dyspnea and fatigue","volume":"40","author":"PM Meek","year":"2003","journal-title":"J Rehabil Res Dev"},{"issue":"3","key":"pone.0246767.ref026","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/alcalc\/37.3.245","article-title":"Alcohol use among Swedes and a psychometric evaluation of the alcohol use disorders identification test","volume":"37","author":"H Bergman","year":"2002","journal-title":"Alcohol Alcohol"},{"key":"pone.0246767.ref027","unstructured":"World Health O. AUDIT: the Alcohol Use Disorders Identification Test: guidelines for use in primary health care \/ Thomas F. Babor \u2026 [et al.]. 2nd ed ed. Geneva: World Health Organization; 2001."},{"key":"pone.0246767.ref028","unstructured":"The Swedish translation of AUDIT questionnaire. Available from URL: http:\/\/dok.slso.sll.se\/BeroendeC\/AUDIT.pdf (accessed on 29\/11\/2020)."},{"issue":"1","key":"pone.0246767.ref029","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1513\/AnnalsATS.201808-564PS","article-title":"Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals","volume":"16","author":"DJ Lederer","year":"2019","journal-title":"Annals of the American Thoracic Society"},{"issue":"1","key":"pone.0246767.ref030","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.010440","article-title":"Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy","volume":"8","author":"JR Tietjens","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"pone.0246767.ref031","first-page":"159","article-title":"Effects of disulfiram on the sleep of chronic alcoholics","volume":"8","author":"S Snyder","year":"1981","journal-title":"Curr Alcohol"},{"issue":"11","key":"pone.0246767.ref032","doi-asserted-by":"crossref","first-page":"4990","DOI":"10.1210\/jc.2019-01132","article-title":"Hypothyroidism and Its Association With Sleep Apnea Among Adults in the United States: NHANES 2007\u20132008","volume":"104","author":"S Thavaraputta","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"pone.0246767.ref033","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1682\/JRRD.2009.11.0181","article-title":"Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF\/OEF veterans","volume":"47","author":"RJ Spencer","year":"2010","journal-title":"J Rehabil Res Dev"},{"issue":"3","key":"pone.0246767.ref034","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1037\/pag0000445","article-title":"More or less energy with age? A motivational life-span perspective on subjective energy, exhaustion, and opportunity costs","volume":"35","author":"BB Cardini","year":"2020","journal-title":"Psychol Aging"},{"issue":"3","key":"pone.0246767.ref035","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s10096-018-03447-1","article-title":"Assessment of the tau protein concentration in patients with tick-borne encephalitis","volume":"38","author":"P Czupryna","year":"2019","journal-title":"European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology"},{"issue":"1","key":"pone.0246767.ref036","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12974-020-01756-x","article-title":"Pathological modeling of TBEV infection reveals differential innate immune responses in human neurons and astrocytes that correlate with their susceptibility to infection","volume":"17","author":"M Fares","year":"2020","journal-title":"J Neuroinflammation"},{"issue":"4","key":"pone.0246767.ref037","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/10790268.2016.1168587","article-title":"Central fatigue in multiple sclerosis: a review of the literature","volume":"39","author":"P Newland","year":"2016","journal-title":"J Spinal Cord Med"},{"issue":"5","key":"pone.0246767.ref038","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1136\/thoraxjnl-2017-210431","article-title":"Polysomnographic phenotypes and their cardiovascular implications in obstructive sleep apnoea","volume":"73","author":"AV Zinchuk","year":"2018","journal-title":"Thorax"},{"issue":"4","key":"pone.0246767.ref039","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01783-19","article-title":"Tick-Borne Encephalitis Virus Nonstructural Protein 1 IgG Enzyme-Linked Immunosorbent Assay for Differentiating Infection versus Vaccination Antibody Responses","volume":"58","author":"P Girl","year":"2020","journal-title":"J Clin Microbiol"},{"issue":"3","key":"pone.0246767.ref040","first-page":"17","article-title":"Distinction between serological responses following tick-borne encephalitis virus (TBEV) infection vs vaccination, Sweden 2017","volume":"23","author":"B Albinsson","year":"2018","journal-title":"Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin"},{"issue":"1","key":"pone.0246767.ref041","article-title":"Tick-Borne Encephalitis Virus Vaccines Contain Non-Structural Protein 1 Antigen and may Elicit NS1-Specific Antibody Responses in Vaccinated Individuals","volume":"8","author":"J Salat","year":"2020","journal-title":"Vaccines (Basel)"},{"issue":"4","key":"pone.0246767.ref042","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.smrv.2013.12.002","article-title":"Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives","volume":"18","author":"M Bruyneel","year":"2014","journal-title":"Sleep Med Rev"},{"issue":"1","key":"pone.0246767.ref043","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/01.wnp.0000190416.62482.42","article-title":"Objective measures of sleepiness and wakefulness: application to the real world?","volume":"23","author":"MS Wise","year":"2006","journal-title":"J Clin Neurophysiol"},{"issue":"10","key":"pone.0246767.ref044","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.5665\/sleep.6160","article-title":"Post Tick-Borne Encephalitis Virus Vaccination Narcolepsy with Cataplexy","volume":"39","author":"H Hidalgo","year":"2016","journal-title":"Sleep"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246767","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T19:34:39Z","timestamp":1612812879000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246767"}},"subtitle":[],"editor":[{"given":"Heming","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,8]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0246767","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,8]]}}}