Appearance gives you the option of a light or dark UI for the Mac app, regardless of your system settings (macOS Mojave 10.14 or later).
Canvas gives you the option of a light or dark canvas, regardless of your Appearance setting.
App Icon gives you the option to select a different app icon for Sketch.
Open & Save to gives you the choice of opening and saving from/to a Workspace or locally by default.
Auto Save is enabled by default and automatically saves documents as you work. For local documents, this includes access to previous saves using the macOS Versions feature.
Command Bar lets you set a custom shortcut to open it, and you can also make it the default tool for replacing Components.
Dialogs can reset all warning dialogs you see in the app, should you wish to see them all again.