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.
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Clinical · Comorbidities · continued
Obstructive sleep apnoea and a hard endpoint in this class posts 91–120
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist.
Small point, but it is the one that usually catches people.
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a.kowalski, post #4: 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. Go to post
This follows post #91 rather than contradicting it.
Obstructive sleep apnoea is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.
MSaarinen, post #87: A definition problem is doing most of the work in this obstructive sleep apnoea discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small. Go to post
The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about.
If that reads as pedantic, it is, and it has saved me twice.
Adding a reference point for obstructive sleep apnoea. Mine is a single case, collected without controls, and I am posting the method alongside it so it can be discounted appropriately.
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On post #95 — agreed on the reasoning, with one qualification.
Thyroid history and the C-cell finding is the clearest documented contraindication in this class and is specific rather than general.
The evidence for this is thinner than the way I have phrased it suggests.
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Picking up post #95: that is the part I would want checked first.
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.
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Answering the question post #95 raises rather than the one it answers.
The honest answer on obstructive sleep apnoea is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.
Most people get the first two right and then argue about the fourth.
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The arithmetic in post #99 is right; the assumption feeding it is the part to check.
Checked the obstructive sleep apnoea claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.
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MSaarinen, post #87: A definition problem is doing most of the work in this obstructive sleep apnoea discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small. Go to post
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.
Happy to be corrected if someone holds better data than mine.
The arithmetic in post #99 is right; the assumption feeding it is the part to check.
I would call the community position on obstructive sleep apnoea likely rather than established, and I would be comfortable defending that hedge.
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Where I part company with post #99, and it is a narrow parting.
Summarising the obstructive sleep apnoea thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.
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Nothing here is medical advice and clinicians posting in this subcategory say so on their own account rather than because a rule requires it.
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j.nwosu, post #80: 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. Go to post
Everything in post #103 holds. The case it does not cover is the one I have.
Genuine question rather than a rhetorical one: has anyone here actually observed obstructive sleep apnoea, as opposed to read about it? The thread is long and I cannot tell.
a.wikstrom, post #57: I read post #55 twice before replying, because I had assumed the opposite. Answering the obstructive sleep apnoea question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the first measurement was taken. Go to post
Narrowing post #103, because the general version has more than one answer.
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.
Gastrointestinal conditions interact with a mechanism that slows gastric emptying in ways that are plausible and largely unstudied.
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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.
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A methods point on obstructive sleep apnoea rather than a substantive one: if the comparison is not like for like, the difference you are measuring is the difference in method.
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s.grigorescu, post #110: A methods point on obstructive sleep apnoea rather than a substantive one: if the comparison is not like for like, the difference you are measuring is the difference in method. Go to post
Adding a data point of agreement rather than a data point.
Ziegler, post #62: This is the answer, and the reason it is the answer is the more useful part. Go to post
Two sentences on obstructive sleep apnoea and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
t.lindqvist, post #88: 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. Go to post
Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.
The honest answer is that it depends, and here is what it depends on.
cannula_trace, post #12: 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. Go to post
Narrowing post #114, because the general version has more than one answer.
One caution on obstructive sleep apnoea: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.
Adding a small correction to the obstructive sleep apnoea summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
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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.
Worth saying I have only my own numbers here, and n is small.
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f.amankwah, post #2: Reading back through, this was answered upthread and I missed it. My fault. Go to post
Second this, and I would have said it less carefully.