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Background Poor acoustic conditions at home can have negative health impact. The aim was to investigate home environment factors and medical symptoms associated with noise disturbance. Methods All adults (≥18 y) registered in selected apartments in Sweden were invited to participate in a questionnaire survey including medical questions and personal factors. Totally 5775 adults participated (response rate 46%). Information on home environment was obtained through an indoor environment questionnaire. Two-level logistic regression models (individual, municipality) were performed to estimate associations. Results Totally 11.9% reported noise disturbance in general at home. Noise disturbance from voice/radio/TV/music/similar sounds from neighbours (13.2%), scraping sound/footsteps/thumping from neighbours (16.5%) and road traffic (16.1%) were common. Younger age and smoking were related to more noise disturbance and more medical symptoms. Noise disturbance was related to tiredness, headache and difficulty concentrating (OR = 1.70–8.19). Renting the apartment (OR = 2.53) and living above ground floor (OR = 1.37) were related to more noise disturbance in general. Living in newer buildings (constructed from 1986 to 2005) was related to less noise disturbance in general (OR = 0.40–0.59). A warmer climate (OR = 1.95), higher municipality population density (OR = 1.24), a longer living time (OR = 1.34), construction year (1961–1975) (OR = 2.42), renting (OR = 1.80–2.32), living above ground floor (OR = 1.45) and having a bathroom fan (OR = 1.84) were associated with increased noise disturbance from neighbours. Factors associated with increased noise disturbance from installations or ventilation/fans/heat pumps included a warmer climate, higher municipality population density, construction year (1961–1995), renting and any mechanical ventilation. Higher municipality population density, construction year (especially 1961–1985) and renting were associated with more noise disturbance from traffic (OR = 1.77–3.92). Renting the apartment (OR = 1.73) and living above ground floor (OR = 1.60) were related to more severe traffic noise disturbances. Noise disturbance in general was partly a mediator of the effects of old buildings, renting the apartment and lack of mechanical ventilation on medical symptoms (% of total effect mediated by noise disturbance: 19–44.8%). Conclusions Noise disturbance can be associated medical symptoms. Younger age, smoking, a warmer climate, higher municipality population density and different building factors (e.g. renting the apartment, construction period 1961–1985) can be associated with noise disturbance.