We prove decomposition theorems for sparse positive (semi)definite polynomial matrices that can be viewed as sparsity-exploiting versions of the Hilbert--Artin, Reznick, Putinar, and Putinar--Vasilescu Positivstellensätze. First, we establish that a polynomial matrix $P(x)$ with chordal sparsity is positive semidefinite for all $x\in \mathbb{R}^n$ if and only if there exists a sum-of-squares (SOS) polynomial $σ(x)$ such that $σP$ is a sum of sparse SOS matrices. Second, we show that setting $σ(x)=(x_1^2 + \cdots + x_n^2)^ν$ for some integer $ν$ suffices if $P$ is homogeneous and positive definite globally. Third, we prove that if $P$ is positive definite on a compact semialgebraic set $\mathcal{K}=\{x:g_1(x)\geq 0,\ldots,g_m(x)\geq 0\}$ satisfying the Archimedean condition, then $P(x) = S_0(x) + g_1(x)S_1(x) + \cdots + g_m(x)S_m(x)$ for matrices $S_i(x)$ that are sums of sparse SOS matrices. Finally, if $\mathcal{K}$ is not compact or does not satisfy the Archimedean condition, we obtain a similar decomposition for $(x_1^2 + \ldots + x_n^2)^νP(x)$ with some integer $ν\geq 0$ when $P$ and $g_1,\ldots,g_m$ are homogeneous of even degree. Using these results, we find sparse SOS representation theorems for polynomials that are quadratic and correlatively sparse in a subset of variables, and we construct new convergent hierarchies of sparsity-exploiting SOS reformulations for convex optimization problems with large and sparse polynomial matrix inequalities. Numerical examples demonstrate that these hierarchies can have a significantly lower computational complexity than traditional ones.