Optimizing CPAP Adherence in Obstructive Sleep Apnea: A Narrative Review of Practical Strategies for Everyday Clinical Care

Background: Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnea (OSA). Despite improvements in CPAP technology and management, adherence to therapy remains one of the main challenges to be addressed. Methods: We conducted a narrative review through PubMed (1995–2026). Studies were selected by clinical relevance, methodological quality and expert consensus. Results: OSA treatment outcomes are poor when CPAP adherence is defined as four hours per night. The first step in improving adherence is active patient involvement. This involves explaining what OSA is, its consequences, what PAP therapy is, and its potential benefits. The choice of the right mask is the first personalized step in CPAP adherence. OSA phenotype and endotype traits may help personalize treatment in selected patients, although their role in predicting CPAP adherence needs to be studied in greater depth. Problems during the first night and the first month are the main predictors of future adherence. Strategies such as cognitive behavioral therapy or motivational enhancement can improve adherence, especially during the initial period. Long-term adherence can be predicted from the initial period and maintained through scheduled follow-up. Group meetings, telephone calls and telemedicine interactions are also a valid way of improving adherence. Conclusions: Patients should initially be educated about how their symptoms are related to sleep apnea and how CPAP treatment could resolve them. The key to improving CPAP adherence is involving patients in personalized treatment with scheduled follow-up, particularly during the initial treatment period.