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Introduction We aim to quantify adherence of positive airway pressure (PAP) initiated during the COVID-19 pandemic and compare the effects of remote versus face-to-face (FTF) education in patients with obstructive sleep apnoea (OSA). Methods Prospective cohort study in a tertiary National Health Service (NHS) hospital sleep disorders centre in London, United Kingdom, involving 141 patients aged >18 years with newly diagnosed OSA initiating PAP during the first national coronavirus (COVID-19) lockdown in 2020. We compare 70 patients educated on PAP remotely to 71 patients receiving standard FTF education. We measured adherence over a continuous 30-day period within the first three months of PAP usage, including average nightly usage, usage per nights used, percentage of nights used, and percentage of nights used for >4 hours. Results Of 141 patients, there was a two-thirds male predominance, and half of the patients (56%) above 45 years of age and sleepy at baseline (Epworth Sleepiness Score >10, 48.9%). 114 patients (81%) were diagnosed with moderate or severe OSA. 54 patients (38.3%) achieved good adherence (≥70% of nights with ≥4 hours usage), with an average of 4.7 hours of PAP usage per night used. Patients receiving FTF PAP education had a comparable level of good adherence (38.03% versus 38.57%, p=0.915), and hours per nights used (4.76 versus 4.61 h/night, p=0.711) to remotely educated patients. More severe OSA, lower mask leak, and a nasal mask were associated with achieving good PAP adherence. Discussion PAP adherence of newly diagnosed individuals with OSA during the COVID-19 pandemic was modest at 38.30%, and not significantly affected by remote PAP education delivery, but rather the effects of the COVID-19 pandemic.