Academic stress and anxiety are common challenges among medical students worldwide, significantly affecting both mental health and academic performance. In Albania, where institutional mental health support is still developing, the interplay between stress, anxiety, and sleep quality remains underexplored. This study investigates the mediating role of anxiety and the moderating influence of sleep quality on the relationship between academic stress and student performance among Albanian medical students. Drawing on previous findings that link poor sleep quality to higher stress, anxiety, and academic burnout, the study highlights the importance of targeted interventions to improve sleep and mental health outcomes. The results underscore that addressing both anxiety and sleep quality is crucial for enhancing academic performance and overall well-being in this population.