Central apneas are a prevalent yet complex phenomenon, particularly among children. This retrospective study, conducted over a decade (from 2012 to 2022), analyzed central apneas in a cohort of 612 pediatric patients who underwent ventilation at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy. Among this group, 67 patients met the inclusion criteria for central apneas. Central apneas often arise within the context of various underlying pathologies, including neurological disorders, genetic syndromes, and brain tumors. We categorized patients into three main groups including patients with “exclusively central apneas”, “predominantly central apneas”, and “predominantly obstructive apneas”. Ventilation modes were diverse, with pressure-controlled ventilation and pressure support being commonly used, reflecting the individualized nature of therapy. The choice of ventilation mode has been influenced by the underlying diagnosis and the severity of central apneas, with pressure support ventilation being the most frequently employed mode. Continuous Positive Airway Pressure was also employed in select cases. A statistically significant reduction (p<0.05) in mean cAHI was observed in patients with multimalformation syndromes, hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction in mean cAHI was not statistically significant in the case of patients with brain tumors. While non-invasive ventilation was commonly used, invasive mechanical ventilation was selectively employed in more severe cases. The study highlights the need for personalized therapeutic strategies when managing central apneas in pediatric patients.