In this review, the factors affecting the transfer of oxygen in activated sludge processes using fine-pore diffusers for water resource recovery are critically discussed. In water resource recovery facilities, the energy required for aeration constitutes 50% to 80% of the total energy consumed by the plant. This critical review highlights the use of fine-pore diffuser aeration and emphasizes the significance of accounting for the following factors: diffuser aging and fouling, diffuser layout, diffuser type, selector benefits, local environmental conditions (temperature and atmospheric pressure), influent wastewater variability, dissolved oxygen control systems, and airflow rates. In our review, we were unable to find mathematical models that could be used to develop dynamic α-factor predictions and diffuser fouling predictions. Although the development of a model that considers all the factors that affect oxygen transfer efficiency (OTE) in activated sludge systems would be extremely valuable, the creation of such a model is outside the scope of this review.