Background This ongoing study aims to examine the potential cognitive and psycho-social benefits of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep apnea (SA). Methods This study included adults with chronic SCI who underwent a 4-month trial of CPAP therapy for management of recently diagnosed moderate-to-severe SA. Outcome measures included the Epworth Sleepiness Scale (ESS), Medical Outcomes Study Sleep Scale (MOS-SS), Fatigue Severity Scale (FSS), Depression, Anxiety & Stress Scale-21 (DASS-21), Montreal Cognitive Assessment (MoCA), SF-36, and Craig Handicap Assessment & Reporting Technique (CHART). The participants were also asked about their lived experience before and after CPAP trial (qualitative analysis). Results By February 2023, we screened 33 individuals (10 females, 23 males; age range: 37-79 years; mean age: 58.3 years) with motor complete (n=15) or incomplete SCI at cervical (n=22) or thoracic levels. Time since SCI varied from 4 to 793 months. The apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events/hour. Of the 33 individuals, 25 participants with moderate-to-severe SA initiated CPAP therapy; 19 individuals have completed the CPAP trial. Daytime sleepiness and sleep quality, fatigue and quality of life significantly improved with CPAP therapy. There was a trend for improvement of cognitive, mental health and participation scores, but they have not reached significance yet (p=0.079, p=0.207, p=0.221, respectively). Conclusions Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and quality of life, and mitigates daytime sleepiness, fatigue, and anxiety in people with chronic SCI.