Background: Sleep quality is a critical determinant of cognitive function and academic performance, especially among medical students facing rigorous academic demands. Disrupted sleep patterns are commonly reported in this group, potentially impacting their learning outcomes. This study aimed to assess the association between sleep quality and academic performance in final-year MBBS students. Materials and Methods: A cross-sectional study was conducted among 150 final-year MBBS students from a tertiary medical college. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and academic performance was measured using recent internal examination scores. Students were categorized into good sleepers (PSQI score ≤5) and poor sleepers (PSQI score >5). Statistical analysis was performed using SPSS v26, and Pearson’s correlation and independent t-tests were used to assess relationships between sleep quality and academic scores. Results: Out of 150 participants, 92 (61.3%) were identified as poor sleepers. The mean PSQI score for the entire cohort was 7.1 ± 2.6. Students with poor sleep quality had significantly lower academic scores (mean = 58.3 ± 6.9) compared to those with good sleep quality (mean = 64.7 ± 7.2), p< 0.01. A moderate negative correlation (r = –0.42, p< 0.001) was found between PSQI scores and academic performance. Conclusion: Poor sleep quality is highly prevalent among final-year MBBS students and is significantly associated with reduced academic performance. Interventions to improve sleep hygiene may contribute to better learning outcomes in medical education.