Rethinking CPAP adherence with artificial intelligence

Obstructive sleep apnea is a prevalent disorder associated with impaired quality of life and increased cardiometabolic risk, ultimately leading to heightened overall mortality. The first-line therapy is continuous positive airway pressure (CPAP), yet its effectiveness is limited by patient adherence. Follow-up protocols for CPAP management lack individualization, resulting in poor adherence and unnecessary costs. Artificial intelligence (AI) recently emerged as a promising strategy to address these limitations through enabling data-driven, individualized CPAP management. This narrative review synthesizes the extant evidence derived from 60 peer-reviewed studies published between 2017 and 2025 that applied AI to CPAP adherence. We focus on three complementary domains: (i) unsupervised learning methods to identify patient phenotypes and adherence trajectories, (ii) supervised models to predict short- and long-term adherence, and (iii) AI-enabled digital monitoring and intervention tools designed to improve sustained adherent CPAP use. AI-based approaches have consistently shown predictability, identifying early robust adherence patterns; these support the possibility of targeted, proactive interventions. Collectively, these findings suggest the need for a paradigm shift from "one size fits all" to personalized, behaviorally informed CPAP care. Future work should prioritize clinical validation, model interpretability, integration into care pathways, and real-world effectiveness to enable translation into routine clinical practice.