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Mean opinion scores (MOS) are widely used for speech quality assessment, yet scalar labels are sensitive to rater variability and listening test differences. This introduces labeling noise, which limits the reliability of MOS prediction. Preference prediction reduces this variability as listeners compare signals directly, producing cleaner labels. We study MOS-free preference prediction and propose PrefSQA, which incorporates uncertainty-aware logits, an impairment attention head, and a module based on non-matching-reference comparisons. We use and refine five datasets, including MOS-derived and low-noise simulated sets with matching and non-matching content, experiment with human preference sets, and test on unseen data. Experiments show small improvements on MOS-derived data, while other sets reveal clear improvement over the baselines, highlighting the value of high-quality preference data and demonstrating the effectiveness of the proposed method.