On the subject in the title: Obstructive sleep apnoea and a hard endpoint in this class Working notes rather than a conclusion.
I was wrong about obstructive sleep apnoea in a thread last spring and I would like to correct it publicly rather than quietly.
The error was in the units, which changed the conclusion by an order of magnitude. Setting out the corrected version, and the way I now check for that class of mistake.
Reading back through, this was answered upthread and I missed it. My fault.
Narrowing the opening post, because the general version has more than one answer.
Whatever the answer on obstructive sleep apnoea turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.
Chronic kidney disease: compounds in this class have renal benefit in people with kidney disease. The benefit appears to be additive to other renal-protective agents, not a replacement for them.
What I would check first on obstructive sleep apnoea is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.
Filing a mild objection to the consensus on obstructive sleep apnoea. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.
Post #6 answers the question as asked. The question underneath it is different.
Comorbidity control: if a comorbidity (high blood pressure, high lipids) is not adequately controlled, the decision about adding compounds in this class depends on the current control status, not on the compound alone.
I am describing what is, rather than arguing for what should be.
I read post #4 twice before replying, because I had assumed the opposite.
The number people quote for obstructive sleep apnoea is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
Post #6 is the version of this I will quote in future. One addition.
Renal function affects clearance for some compounds in this class and not others. The published data is compound-specific and is worth checking rather than generalising.
It reads as pedantry until the day it does not.
Where I part company with post #8, and it is a narrow parting.
Obstructive sleep apnoea: SURMOUNT-OSA used an objective endpoint, the apnoea-hypopnoea index. Reduction was substantial. Whether the benefit is weight loss or a direct drug effect is not resolved by the trial.
The claim about obstructive sleep apnoea upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".
PCOS and metabolic overlap: polycystic ovary syndrome has metabolic overlap with obesity and insulin resistance. Data on compounds in this class in PCOS specifically is thin; most discussion is by mechanism.
Not disagreeing with anyone above, just adding the bit I keep having to look up.
Post #11 and I disagree about the size of the effect, not about the direction.
Obstructive sleep apnoea has a well-known answer and a correct answer, and the interesting work is establishing that they are the same. Nobody has done that here yet.
Taking post #11 at face value and following it one step further.
The documentation on obstructive sleep apnoea is better than this thread and I say that as someone who has posted in the thread.
Post #15 answers the question as asked. The question underneath it is different.
Thyroid history and the C-cell finding is the clearest documented contraindication in this class and is specific rather than general.
That is a description of practice, not a recommendation of it.
That is consistent with mine, for whatever one more account is worth.
Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.
Post #19 is right about the mechanism and I think understates the practical bit.
Offering a way to settle obstructive sleep apnoea rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision.
Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.
Everything in post #18 holds. The case it does not cover is the one I have.
Obstructive sleep apnoea: SURMOUNT-OSA used an objective endpoint, the apnoea-hypopnoea index. Reduction was substantial. Whether the benefit is weight loss or a direct drug effect is not resolved by the trial.
One of those cases where knowing the mechanism does not help the decision.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
Practical note on obstructive sleep apnoea: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
Source for the obstructive sleep apnoea figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them.
That is the shape of it. The detail is where I would expect to be corrected.