Indoor air quality (IAQ) in high-rise residential buildings is an increasing concern, especially in hot and humid climates where prolonged indoor exposure elevates health risks. This study evaluates the performance of Fresh Air Handling Units (FAHUs) using two complementary approaches: (1) real-time sensor data to quantify IAQ conditions and (2) occupant survey responses to capture perceived comfort and pollution indicators. The results show that floor level did not predict satisfaction, even though AQI data revealed clear differences between flats, suggesting perceptions are driven more by sensory cues than by actual pollutant levels. Longer weekday exposure emerged as a stronger predictor of dissatisfaction. These gaps between perceived and measured IAQ highlight the need for improved ventilation scheduling and greater occupant awareness. FAHUs were found to be inefficient, consuming 21–26% of total building energy while lacking pollutant-specific monitoring capabilities. To address these issues, the study recommends the integration of IoT-enabled sensors for real-time pollutant detection, enhanced facade sealing to minimize external infiltration, and the upgrade of filtration systems with HEPA filters and UV purification. Additionally, AI-driven predictive maintenance and automated ventilation optimization through Building Management Systems (BMS) are suggested. These findings offer valuable insights for improving IAQ management in high-rise buildings, with future research focusing on AI-based predictive modeling for dynamic air quality control.