Obstructive sleep apnoea and a hard endpoint in this class posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Obstructive sleep apnoea is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.
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.
I am not the right person to answer the follow-up to this.
Narrowing post #64, because the general version has more than one answer.
Where I would push back on the obstructive sleep apnoea consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.
Everything in post #63 holds. The case it does not cover is the one I have.
Having read the whole obstructive sleep apnoea thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.
Thyroid history and the C-cell finding is the clearest documented contraindication in this class and is specific rather than general.
That is one dataset and I would not build a rule on it.
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.
I think the obstructive sleep apnoea question is answerable and has not been answered, which is a more optimistic position than most of this thread.
Where the obstructive sleep apnoea reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.
On post #69 — agreed on the reasoning, with one qualification.
Where two conditions pull in opposite directions, that is a clinical judgement rather than a lookup, and it is the kind of question a forum answers worst.
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.
Obstructive sleep apnoea: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
Post #73 is right about the mechanism and I think understates the practical bit.
An observation about obstructive sleep apnoea that I cannot explain and am posting anyway, on the principle that unexplained observations are more useful public than private.
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 have three months of notes on obstructive sleep apnoea and the honest summary is that the trend is real and the week-to-week numbers are noise. I nearly drew the opposite conclusion from the first fortnight.
The arithmetic in post #77 is right; the assumption feeding it is the part to check.
Something worth flagging about obstructive sleep apnoea: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.
A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.
Picking up post #81: that is the part I would want checked first.
On obstructive sleep apnoea, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.
On post #80 — agreed on the reasoning, with one qualification.
Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.
A partial answer, offered because a partial answer beats none.
I will take the caveat as seriously as the claim, which is the point of putting it there.
Post #84 describes the usual case. This is about the unusual one.
The version of obstructive sleep apnoea that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.
Post #86 answers the question as asked. The question underneath it is different.
A history of pancreatitis appears in the cautions for this class and the decision around it is one that needs a clinician who knows the history.
I have no interest in any supplier named above.
I read post #88 twice before replying, because I had assumed the opposite.
I have been on both sides of the obstructive sleep apnoea argument in this category within eighteen months, which should tell you how strong the evidence for either side is.