SOLVED - “Allow screen tearing” was ON and caused this issue. 
I have some constant stuttering on my current setup. Every 4-5 seconds, almost like a hiccup, I drop about 100 ms worth of frames.
Video:
https://picoshare.jau.nz/-VnpPP8z6xR
Full specs:
5600X
3080 Ti on 570.124.04
Nobara with KDE
Wayland
This has been persistent through several GPU driver updates and I’m tired of trying to troubleshoot it. I don’t know what the exact cause is. Any ideas?
Also, related note, how easy is it to migrate from one distro to another? I am thinking about trying something else - maybe base Fedora or Arch - to hopefully have better performance.
Are you using multiple screens and have something open on another screen that periodically rerenders? I have had a similar problem when having Ksysguard open on a second screen - every time the graphs rendered a new time step, my game lagged. Only happened on Wayland. My solution was to run the game inside of gamescope or to close the offending application.