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To evaluate the associations between problematic Internet use (PIU) and physical and psychological symptoms among Chinese adolescents, and to investigate the possible role of sleep quality in this association.A cross-sectional school-based study was conducted in 4 cities in China. The Multidimensional Sub-health Questionnaire of Adolescents, the Pittsburgh Sleep Quality Index, and demographic variables were used to measure adolescents' physical and psychological symptoms and sleep quality, respectively, in 13,723 students (aged 12–20 years). Problematic Internet use was assessed by the 20-item Young Internet Addiction Test. Logistic regressions were used to evaluate the effects of sleep quality and PIU on physical and psychological symptoms, and to identify the mediating effect of sleep quality in adolescents.Prevalence rates of PIU, physical symptoms, psychological symptoms, and poor sleep quality were 11.7%, 24.9%, 19.8%, and 26.7%, respectively. Poor sleep quality was found to be an independent risk factor for both physical and psychological symptoms. The effects of PIU on the 2 health outcomes were partially mediated by sleep quality.Problematic Internet use is becoming a significant public health issue among Chinese adolescents that requires urgent attention. Excessive Internet use may not only have direct adverse health consequences but also have indirect negative effects through sleep deprivation.