Sleep-related health problems are under investigated among adolescents in low-income countries, including our country, Ethiopia. Therefore, this study aimed to assess the sleep quality and its associated factors among adolescents aged 10 to 19 years in Ethiopia. A community-based cross-sectional study was conducted among 799 adolescents from May 27 to July 27, 2021, using a systematic random sampling technique. Sleep quality was assessed by using the Petersburg sleep quality index. The data was entered into Epi-data version 3.1 and exported to the Statistical Package for Social Science (SPSS) Version 21. A logistic regression model was used, and variables with a P-value less than .05 in the final fitting model were stated as independent predictors of poor sleep quality (PSQ). About 1 in 3 adolescents (38%) had a poor sleep quality. The rates of inhalant, khat, and internet use disorders were 16%, 38%, and 18%, respectively. Also, 27.4% of adolescents used alcohol as a sleep medication, and 75% of adolescents with internet addiction had PSQ. Moreover, adolescents with physical illness had about 4 times higher odds of association with PSQ (AOR = 3.76 and 95% CI = 2.30-6.15%CI), and inhalant use disorder (AOR = 1.98 and 95% CI = 1.29-3.04%CI), internet addiction (AOR = 3.33 and 95% CI = 2.09-5.30%CI), and khat use disorder (AOR = 1.74 and 95% CI = 1.11-2.73%CI), were positively associated with PSQ. PSQ was higher among adolescents, and problematic inhalants, khat, and internet use and physical illness were risk factors for PSQ.