Which describes how obstructive sleep apnea promotes cardiovascular disease?

• A. Apnea episodes cause BP to drop.
• B. After apneic episodes, blood pressure can reach extremely high levels, with hemodynamic stress due to hypoxia and SNS activation.
• C. OSA directly lowers cholesterol.
• D. CPAP worsens CVD risk.

Answer: (B)

The key idea is that obstructive sleep apnea creates intermittent drops in oxygen and repeated arousals that drive a surge in sympathetic activity, causing large blood pressure spikes during sleep. After each apneic event, chemoreceptors and cortical arousal provoke a rapid sympathetic response, pushing blood pressure and heart rate to high levels. Over many cycles, these nocturnal surges raise overall blood pressure, increase cardiac workload, and promote hypertensive and ischemic changes. The repeated hypoxia also fuels oxidative stress and inflammation, damaging the endothelium and accelerating atherosclerosis, which together raise the risk of cardiovascular disease.

Thus, the description of blood pressure reaching very high levels after apneic episodes, with hemodynamic stress from hypoxia and SNS activation, best captures how OSA promotes cardiovascular disease.

The other statements don’t fit: apnea does not cause a drop in BP, OSA does not directly lower cholesterol, and CPAP generally reduces cardiovascular risk rather than worsening it by decreasing apnea burden and related stress.