Positive airway pressure (PAP) is considered the gold standard treatment for obstructive sleep apnea (OSA). Nonetheless, suboptimal adherence to this treatment frequently limits its potential for achieving optimal therapeutic outcomes. Previous research studies have examined the efficacy of educational, supportive, and behavioral interventions, demonstrating substantial promise in optimizing treatment outcomes [1]. However, the labor-intensive nature of these interventions poses challenges for their practical implementation. More recently, telemedicine-based interventions have emerged as a more efficient approach to mitigating these challenges, and existing evidence has indicated their efficacy in extending adherence to PAP therapy [2].

In this edition of the Journal, Franke et al. present the findings of a 12-week randomized trial involving 100 patients with severe OSA, aimed at examining efficacy of a digital patient support tool in optimizing outcomes during the initial 12 weeks following PAP initiation [3]. The authors found a 1.7-point improvement in the Epworth Sleepiness Scale score and a 70-min per day increase in PAP adherence in the intervention group compared to standard care recipients. These findings corroborate the notion that digital feedback and support can amplify patient engagement and adherence to PAP therapy.

OSA parallels other lifestyle-related diseases like hypertension and diabetes, wherein patient engagement and behavioral modification are crucial for therapeutic success. OSA thus represents a substantial opportunity for the incorporation of patient engagement tools. Furthermore, considering the limited availability of specialists in sleep medicine and the prevalence of OSA within the working-age population, telemedicine—surmounting the constraints of time and location—is exceptionally apt and complementary in meeting the diverse and specialized needs of this medical field. When employing such tools, minimizing the burden on healthcare providers is essential, necessitating a proactive role by patients in disease management through automated feedback and enhanced self-management.

Several studies have highlighted the positive impact of patient-centered engagement apps in augmenting adherence to PAP therapy, leveraging big data and propensity score matching [4, 5]. Nonetheless, the lack of randomization in these studies introduces the possibility of selection bias. This is attributed to the likelihood that motivated individuals may preferentially opt for app-based interventions. Conversely, the present study, with its randomized design, alleviates such bias, affirming that automated digital support tools can foster improved patient engagement and PAP adherence by streamlining treatment monitoring, feedback, and access to educational resources.

Early adherence to PAP therapy is undeniably crucial, as it significantly influences long-term adherence and, consequently, treatment outcomes. However, the paramount objective is not merely to enhance treatment outcomes during the initial phases of PAP therapy but to ensure the continuous and consistent adherence to treatment to improve quality of life and prevent long-term complications. For maintaining PAP adherence, it is imperative that patients actively engage in behavioral modifications pertinent to treatment. The efficacy of digital support tools in promoting such long-term adherence also warrants further investigation to validate their role in sustaining treatment engagement and optimizing therapeutic outcomes.

The advent of telemedicine and digital tools in managing OSA opens new horizons in healthcare. Future endeavors should focus on optimizing these innovations, verifying their efficacy, and exploring their potential to enhance patient adherence to treatment.