Obstructive sleep apnea (OSA) is a common disorder involving repeated upper airway collapse during sleep, contributing to cardiovascular, metabolic, and neurocognitive complications. Standard treatments include weight loss, oral appliances, surgery, and continuous positive airway pressure (CPAP), the gold standard, though its use is often limited by poor adherence. Pharmacotherapy presents a promising alternative or adjunct by targeting key pathophysiological mechanisms such as airway collapsibility, ventilatory instability, and low arousal thresholds. This article reviews recent studies on both established and emerging pharmacological treatments, including ventilatory stimulants, serotonergic agents, Rapid Eye Movement (REM)-suppressants, acetylcholinesterase inhibitors, and drugs that reduce loop gain or increase arousal thresholds. Medications aimed at weight control and lowering upper airway resistance are also discussed. Combination therapies are being explored for greater effectiveness. While pharmacotherapy remains controversial, ongoing research highlights its potential role within personalized, multidimensional treatment plans. The article concludes with challenges and future directions in optimizing drug-based OSA management.