This study aimed to describe the status and distribution of poor sleep quality among urban residents, assess the level of self-reported environmental noise annoyance, and examine the independent association between noise annoyance and Pittsburgh Sleep Quality Index (PSQI) scores after controlling for potential confounding factors. A cross-sectional study was conducted among 178 urban residents in Ho Chi Minh City between February and April 2026. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness using the Epworth Sleepiness Scale (ESS), and insomnia status was assessed using an insomnia index. Noise annoyance was measured using a self-reported five-point Likert scale. Statistical analyses included Pearson correlation and multiple linear regression, with age, sex, body mass index (BMI), floor level, and adjacent street type included as control variables. The prevalence of poor sleep quality (PSQI > 5) was 68.5%, with a mean PSQI score of 7.92 ± 3.14. The mean noise annoyance score was 3.46 ± 0.89 on a five-point scale, with 61.2% of participants reporting high levels of noise annoyance. Multiple linear regression analysis showed that noise annoyance was the strongest and most statistically significant predictor of poor sleep quality (β = 1.24; standardized β = 0.42; p < 0.001; 95% CI: 0.87–1.61). The model explained 38.4% of the variance in PSQI scores (R² = 0.384; p < 0.001). Environmental noise annoyance was independently associated with poor sleep quality among urban residents in Ho Chi Minh City, with both statistical significance and practical relevance. These findings provide empirical evidence to support recommendations for noise control in urban planning and public health interventions in Vietnam.