Background and aims Sleep related breathing disorders (SRDB) are a cause for significant morbidity among children and adolescents. The aetiology is multifactorial and the treatment strategies address the mechanisms which underlie sleep breathing disorders. The recommendations for non-invasive ventilation (NIV) in children and adolescents with SRDB are well defined and their application increases the quality of life and prevents or delays complications.

The percentage of Romanian children, aged between 18 months and 18 years, who are at risk for SRDB is 9.6% according to a study we conducted in 2015.

The adenotonsillectomy is the first-line therapy for OSAS in children, but up to 50%–75% of the paediatric population may have residual IAH. The high risk for SRDB in our country represents the necessity to increase awareness about continuous positive airway pressure (CPAP) and NIV in paediatric patients and build up multidisciplinary teams.

Methods We will present three cases. One of a 8-year-old girl with snoring and apnea during sleep. The symptoms have persisted even after adenoidectomy and the control polysomnography showed a residual IAH of more than 10/h.

The second case and third case are sister and brother with early onset of congenital myopathy with impairment of facial muscles. The 9 y old girl with a history of sleep apnea, morning headaches, difficulty concentrating, tonsillectomy at age 4; her brother, 13 y old has similar symptoms. Venous blood gas analysis showed acidosis and hypoventilation with pH=7,22 and PCO2=69,8 mmHg for girl and pH=7,32 and PCO2=52,3 mmHg for her brother. The polysomnography also showed hypoventilation and mixt sleep apnea syndrome and after titration both received recommendation and started therapy with NIV bilevel therapy S/T mode with IPAP and EPAP according to tolerance.

Results In the first case the girl had a BMI=21,6 kg/m² and after starting CPAP therapy the quality of sleep improved greatly and daytime symptoms diminished.

The sister and brother with congenital myopathy showed improved quality of life after starting bilevel positive airway pressure (BiPAP) therapy with no headache and better results in school. The boy had a more difficult period of adaptation to the mask.

Conclusions The development of paediatric sleep medicine in Romania needs to increase the level of awareness about all therapeutic options and build up multidisciplinary teams for the management of these issues.

The CPAP therapy is an option for children with SRDB who don’t have a recommendation for adenotonsillectomy or don’t respond to the surgical treatment.

Patients with neuromuscular diseases are at risk for respiratory complications as their condition deteriorates due to progressive loss of respiratory muscle strength. These complications include ineffective cough, nocturnal hypoventilation and ultimately daytime respiratory failure. Respiratory assessments need to include studies in search of nocturnal hypercapnia (awake end- tidal CO2) during sleep and pulse oximetry, in order to identify the right moment to start NIV.

NIV in children needs more hours of sleep than in adults and includes the training of parents. Education should begin as soon as possible after diagnosis and it’s an ongoing process as the disease progresses, and also essential in understanding the disease and treatment. The multidisciplinary team should include paediatrician, pulmonologist, neurologist, psychiatrist and sleep specialist.