Continuous positive airway pressure (CPAP) is highly effective in treating obstructive sleep apnea (OSA). However, this treatment modality relies heavily on patient adherence, and poor adherence to the treatment limits its effectiveness in treating OSA. Strategies to augment adherence are needed in the management of OSA.

The smart watch and linked app provide various health information, including sleep, snoring or oxygen saturation during sleep, exercise, blood pressure, and electrocardiogram. The smart watch and linked app could potentially improve adherence to positive airway pressure (PAP) treatment.

This randomized controlled trial (RCT) aimed to examine whether the use of smart watch and app can increase PAP adherence in patients with OSA.

Inclusion Criteria:

• diagnosed with OSA (apnea-hyponea index [AHI])≥ 5 /h) by type 1 polysomnography
• no prior use of PAP (CPAP or auto-adjusting PAP [APAP]), or no prior use of PAP within the previous 90 days in patients who had received PAP therapy, or current PAP users with average daily usage (all days) < 4 hours within the previous 90 days

Exclusion Criteria:

• patients who refuse PAP therapy
• patients who have used a smart watch (e.g., Galaxy Watch, Apple Watch, etc.) within the previous 90 days
• patients with central sleep apnea or neuromuscular disease
• patients receiving supplemental oxygen therapy due to underlying diseases including heart failure, stroke, chronic obstructive pulmonary disease, interstitial pulmonary disease, hypoventilation syndrome, or whose baseline oxygen saturation is less than 90%
• patients with implanted cardiac pacemakers, defibrillators, or other electronic devices
• patients who are inexperienced in using smartphones, apps, or smart watches
• patients with an inability or unwillingness to provide informed consent