Who Performs Best Under Pressure? The Role of Sleep, Anxiety, and Attention in Exam Performance Across Medical, Law, and Economics Students

Background: Academic performance among university students is shaped by multiple factors, especially during examinations. This study aimed to explore the relationship between sleep quality, executive attention, and anxiety to identify potential predictors of academic performance across different academic fields. Method: Fifty-one students, between 19 and 25 years (M = 20.04, SD = 1.11), enrolled in the second year in Medicine (27.5%), Law (39.2%), and Economics (33.3%) programs at a university in Lisbon. The sample has mostly full-time students (98.04%), and female (68.6%). Data collection took place during examination periods and included: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESE), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), Stroop Test and Go/No-Go task. Results: Our findings revealed significant differences across academic fields: medical students reported poorer sleep quality, law students demonstrated reduced executive attention, and economics students exhibited better sleep but weaker inhibitory control. Sleep quality and state anxiety significantly predicted academic performance, whereas executive attention did not. Conclusions: These results underscore the importance of addressing sleep hygiene and anxiety management among university students, regardless of academic discipline. Institutional initiatives, including structured stress-reduction programs and educational support services, may equip students with the tools to manage academic pressures and enhance cognitive functioning and overall psychological well-being.