Background In obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) use can be suboptimal. Identification of psychosocial characteristics associated with use may inform evidence-based interventions to promote therapy uptake. Methods From March to April 2021, patients (>18 years) on CPAP and enrolled in the myAir companion app (ResMed, San Diego) in the U.S. were invited to complete an e-survey on perceived health status, CPAP experience, and psychosocial characteristics. Guided by the Social Cognitive Theory, we explored the association between 90-day CPAP use and confidence, motivation, social support, and perceived health status. We report outcomes from Elastic net (?) and Firth (OR, 95%CI) logistic regressions (adjusting for age, gender, marital status, CPAP duration, and self-reported BMI and diagnostic apnea hypopnea index), and examine differences by gender. Results 6,796 patients (mean (SD) age: 55 (13) yrs; 42% female) were assessed. Confidence (? = 0.71), motivation to stay on therapy (? = 0.46), self-motivation to seek treatment (? = 0.33), and snoring improvement (? = 0.23) were positive predictors of use. Respectively, in males and females, increased confidence (OR 2.8 (1.6, 4.9) vs. 2.1 (1.0, 4.0)) and perceived improvement in snoring (OR 1.7 (1.1, 2.5) vs. 1.7 (1.2, 2.6)) were positively associated with use. Having a motivator in females (OR 2.5 (1.2, 5.1)) and being self-motivated in males (OR 1.6 (1.1, 2.2)) were also positively associated. Having a partner track usage was negatively associated in both males (OR 0.5 (0.3, 0.7)) and females (OR 0.5 (0.3, 0.7)). Conclusions In OSA, greater confidence, motivation, and symptom improvement may support short-term CPAP use.